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NRCME > MedExaminer > Flashcards

MedExaminer Flashcards

1
Q

Define CMV

A

Commercial Motor Vehicle

  • weight of >10,000lb
  • designed to transport >8ppl for compensation or >15ppl regardless of compensation
  • transports hazardous materials in quantities requiring placard
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2
Q

Requirement to be a commercial driver

A
  1. At least 21years old
  2. Read and speak English
  3. Capable of safely operating CMV
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3
Q

When must BP be confirmed with a 2nd measurement?

A

If >139/89

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4
Q

Hypertension stages

A

1: 140-159/90-99
2: 160-179/100-109
3: >180/110

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5
Q

How long can you certify a drive with history of stage 3 hypertension?

A

Maximum of 6 no once bp controlled <140/90

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6
Q

How long can you certify a driver with hx of stage 1 or 2 hypertension?

A

Maximum of 1yr of bp controlled <140/90

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7
Q

When can a 1-time 3mo certificate be given for hypertension?

A
  1. If driver has stage 2 htn

2. If driver has stage 1 htn without control <140/90

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8
Q

What should you do if the driver has stage 3htn?

A

Disqualify until bp stabilized <140/90

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9
Q

Required parts of UA for CMV exam

A

Specific gravity

Protein

Blood

Sugar

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10
Q

Disqualifying vision (4)

A

Monocular vision (unless federal vision exemption certificate)

Use of corrective lenses where one is for distant vision and one is for near vision

Telescopic lenses

Failure to meet any part of vision testing criteria with either eye

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11
Q

Federal hearing standard

A

The driver must first perceive a forced whisper in ONE EAR at not less than 5f

OR

Not have an average hearing loss in one ear greater than 40db at 500, 1000, and 2000 Hz

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12
Q

When does an audiologist need to evaluate a driver?

A

If driver relies on hearing aids and fails forced whisper test

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13
Q

What are the 3 federal medical exemption programs?

A

Vision

Hearing

Epilepsy

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14
Q

Federal vision requirements

A
  1. Distant monocular and binocular vision of at least 20/40
  2. Field of vision at least 70 degrees in the horizontal meridian in wash eye
  3. Ability to recognize red, green, and amber
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15
Q

If the driver has monocular vision

A

This is disqualifying unless driver has a vision exemption

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16
Q

If peripheral vision test is inconclusive

A

Refer to specialist for precise measurements of peripheral vision

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17
Q

If a driver has monocular vision and has a federal exemption certificate how long can you certify them for?

A

1yr max

Even though exemption certificate is granted for 2yr

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18
Q

What does it mean if a pt is 49 CFR 391.64 “grandfathered”?

A

They participated in a vision study in the 90s and can be certified for up to one year if they present study letter and are otherwise medically qualified

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19
Q

How do cataracts impact vision?

A

Worse glare, esp. oncoming headlights

Diminished overall visual acuity

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20
Q

How does glaucoma impact vision?

A

Peripheral vision deficits

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21
Q

Define aphakia

A

Absence of lens in the eye

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22
Q

How does MD impact vision?

A

Central vision loss

Longer recovery from bright lights

Scotoma

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23
Q

Disqualifying types of retinopathy

A

Diabetic with severe non-proliferation or proliferative diabetic retinopathy

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24
Q

If a driver has uncontrolled vertigo

A

This is disqualifying

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25
Q

If a driver has hx of vertigo when can you certify

A

At least 2mo sx free and dx of

BPPV

Or

Peripheral vestibulopathy

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26
Q

Disqualifying optic disease (3)

A

Meniere’s

Labyrinthine fistula

Nonfunctional labyrinth

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27
Q

How long can you certify a driver with a hearing exemption?

A

Up to 2yr

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28
Q

Initial presentation of CAD(%)

A

50% MI

30% angina

20% sudden death

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29
Q

To be certified the driver with diagnosed CAD needs

A

An annual exam and cardiac clearance

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30
Q

Acceptable echocardiogram

A

LVEF >39%

No pulmonary hypertension
PAP >50% of SBP

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31
Q

Acceptable ETT

A
  • workload capacity >6MET through Bruce II
  • attain HR >85% max unless on beta blockers
  • rise in SBP >20mmHg without angina
  • no significant ST seg depression
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32
Q

Acute MI waiting period

A

2months

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33
Q

Acute MI max certification

A

1yr

If asx for3mo, satisfactory post-MI ett, up to date on biennial ett, and resting LVEF>39%

*for initial post-MI cert echo documenting EF>39% required

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34
Q

Angina Prectoris waiting period

A

3mo without rest angina or change in pattern

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35
Q

Max cert with hx of angina

A

1yr

*no changes in sx in 3mo or rest angina and satisfactory biennial ett

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36
Q

Post-CABG waiting period

A

3mo

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37
Q

Hx CABG max cert

A

1yr

No orthostasis
EF >39%
Cardiology approval
Healed sternum
Annual ett
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38
Q

PCI waiting period

A

1wk

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39
Q

Certification w hx PCI

A

1yr max

Cardiac clearance and biennial ett

No injury to vascular site, ischemic ekg changes or rest angina

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40
Q

If pt has hx of PCI and ett testing is inconclusive what should be obtained?

A

Imaging stress test

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41
Q

ICD

A

Do not certify if or has ICD or ICD-pacemaker

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42
Q

Waiting period post pacemaker implantation

A

1mo if underlying dx must be sinus node dysfunction or Av block

3mo if underlying dx hypersensitive carotid sinus w syncope

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43
Q

Certification with pacemaker

A

Max 1yr with documentation of proper functioning and routine checks

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44
Q

SVT waiting period

A

1mo for Afib*, Post-isthmus ablation a flutter, Av nodal reentrant tach (including with WPW), atrial tachycardia, or junctions tach

*1mo anticoagulant also needed

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45
Q

SVT certification

A

Max 1yr

He controlled and cardiac clearance

*anticoag documents if afib

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46
Q

Ventricular arrhythmia waiting period

A

1mo if cad, RV outflow VT, or idiopathic LV VT

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47
Q

Ventricular arrhythmia certification

A

1yr max

Cardiac clearance required, LVEF >39%

Disqualifying dx: HCM, long QT, brugada

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48
Q

Heart failure certification

A

1yr max

Asx, LVEF >39%, ett satisfactory, annual cardiac clearance

Sustained V tach (30sec or more) is disqualifying

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49
Q

Syncope waiting period

A

3mo following initiation of treatment

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50
Q

Max certification with hx syncope

A

1yr

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51
Q

L3 nerve root impingement

A

Sensory deficiency in lower thigh

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52
Q

L4 nerve root impingement

A

Decreased patella reflex and sensation across knee to medial malleous

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53
Q

L5 impingement

A

Lateral leg and big toe numbness

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54
Q

S1 nerve impingement

A

Numbness of small toe and sole of foot

Decreased Achilles reflex

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55
Q

Certification with congenital heart disease

A

Max 1yr

If asx and dx is mild tricuspid, mild enlargement, or mild right ventricular dysfunction

Annual cardiac eval with echo and provider that specializes in adult congenital heart dz

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56
Q

Heart transplant waiting period

A

1yr

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57
Q

Heart transplant certification

A

Max 6mo

Cardiac clearance Q6mo and no signs of rejection

58
Q

Hypertrophic cardiomyopathy or restrictive cardiomyopathy

A

Do NOT certify

59
Q

AAA rupture risk

A

<4cm is rare

<5 is 1-3% per year

5-6cm is 5-10% per year

> 7cm is approx 20% per year

60
Q

AAA certification

A

Max 1yr

Must be <4cm and asx
Or
4-5cm with vascular clearance

Annual aaa us recommended

61
Q

Post surgical aaa repair waiting period

A

3mo

62
Q

Do NOT certify pt with aaa if…

A

Symptoms

Recommended surgical repair

4-5cm w/o vascular clearance

> 5cm

Hx of >0.5cm growth in 6mo period

63
Q

TAA certification

A

If <3.5cm

Max 1yr and 3mo post surgical wait just like AAA

64
Q

Max cert acute DVT

A

1yr with appropriate anticoag therapy

65
Q

Max cert with chronic thrombotic venous dz

A

2yr

66
Q

Max cert for intermittent claudication

A

1yr

67
Q

Waiting period surgical repair for claudication

A

3mo

68
Q

Max cert superficial phlebitis

A

2yr

69
Q

PE waiting period and max cert

A

3mo w appropriate anticoagulant therapy

1yr

70
Q

Valvular heart disease certification and surgical waiting period

A

Usually max cert 1yr but semi regular echo required

3mo waiting period after surgery unless balloon angioplasty then only 4wk

71
Q

Anticoagulant certification

A

1yr max with

Stabilized on meds for at least 1mo with AF least monthly monitoring and provides copy of INR report at exam

72
Q

How long should driver abstain from driving after taking 1st gen antihistamine?

A

12hr

73
Q

Max cert with allergic rhinitis

A

2yr

74
Q

Max cert with Hx angioedema or anaphylaxis

A

2yr

75
Q

Max cert with asthma

A

2yr

Must be controlled w/o FEV1<65% or hypoxemia (PaO2 <65mmHg)

76
Q

Cert with hypersensitivity pneumonitis

A

2yr

*can not be severe and unmanaged

77
Q

COPD max cert

A

2yr

Can not have rest hypoxemia, chronic resp failure or continued coughing with syncope

78
Q

Pulm TB certification

A

Max 2yr

Must not be contagious, taking med, asx, and stable lung function

(Same guidelines for atypical TB)

79
Q

Certification with chest wall deformities

A

Max 2yr

W/o hypoxemia at rest, chronic resp failure, or constant cough or cough syncope

80
Q

CF max cert

A

1yr with other pulm dz standards, PFTs, and specialist clearance

81
Q

ILD max cert

A

2yr

W/o hypoxemia at rest, chronic resp failure, or constant cough or cough syncope

82
Q

Special requirements for certification of hx spontaneous pneumothorax

A

CXR showing complete resolution

Pleurodesis if hx recurrent disease

Max cert 2yr

83
Q

When should you get PFTs?

A

Hx any lung disease

Sx of SOB, cough, chest tightness or wheezing

84
Q

PFT standards

A

FEV1>65%

FEV1/FVC ratio >65%

FVC >60%

85
Q

When must driver have ABG analysis?

A

Pulse oximetry <92%

86
Q

ABG standards

A

PaO2 not less than
65mmHg below 5000ft
60mmHg above 5000ft

PaCO2 <45mmHg at any altitude

87
Q

Max cert cor pulmonale

A

2yr

W/o sx and satisfactory ABG

88
Q

Pulm htn max cert

A

1yr

89
Q

Epilepsy waiting period

A

At least 10yr off medication and seizure free

90
Q

Single unprovoked seizure waiting period

A

5yr seizure free and off medication

91
Q

Max cert for single unprovoked seizure

A

1yr

Neuro clearance required

92
Q

Acute seizure hx due to systemic metabolic illness

A

Can certify for up to 2yr if underlying metabolic dysfunction has been corrected

93
Q

Max cert if hx of childhood febrile seizures

A

2yr

94
Q

Epilepsy Seizure exemption requirements

A

No seizure for 8yr

Stable therapy and seizure free for 2yr

Annual reports from treating physician

Annual medical exam

95
Q

Duration of seizure exemption

A

2yr but driver still needs annual exams

96
Q

Single unprovoked seizure exemption requirements

A

Seizure Free for at least 4yr on or off meds

Stable meds for 2yr

97
Q

Single provoked seizure exemption requirements

A

Seizure free on or off meds for 8yr

2yr stable meds

Annual recert

98
Q

Single provoked seizures- low risk factors

A

Caused by meds

Non-penetrating head injury with LOC <30min

Metabolic derangement

Alcohol or drug withdrawal

99
Q

Single provoked seizure- high risk factors

A

Non-penetrating head trauma with LOC>30min or amnesia

Penetrating head injury

ICH associated with stroke or trauma

Brain infection

Post-operative complication from brain surg

100
Q

Hx of brain surgery penetrating the dura

A

Should not certify

101
Q

TBI classes

A

Severe: penetrates dura. LOC >24hr. High risk of seizures that does not diminish over time

Moderate: does not penetrate dura and lox 30min -24hr

Mild: no dura penetration and lox <30min

102
Q

TBI waiting period

A

2yr seizure free and off medication for

  • moderate TBI
  • mild TBI with early seizures

5yr seizure free and off meds if moderate TBI with early seizure

103
Q

TBI max certification

A

1yr

Unless mild without early seizures, Then 2yr

Neurologist clearance needed

104
Q

TIA waiting period and max cert

A

1yr and 1yr

105
Q

What areas of the brain when affected by stoke hold a higher risk of seizures?

A

Cortical and subcritical

*cerebellum and brainstorm vascular lesions are NOT associated with an increased seizure risk

106
Q

Stoke minimum waiting period

A

1yr if cerebellum of brain stem

5yr if cortical or subcortical

*neurologist clearance required

107
Q

If driver with CVA/ICH/SAH hx is on Coumadin

A

Do not certify

108
Q

Waiting period after intra cerebral or subarachnoid hemorrhage

A

1yr if cerebellum of brain stem

5yr if cortical or subcortical

*neurologist clearance required

1yr max cert

109
Q

Max cert autonomic neuropathy

A

2yr

-resting tachycardia and orthostatic hypotension are disqualifying

110
Q

Disqualifying conditions of abnormal muscle activity

A

Myotonia

Isaac’s syndrome

Stuff-man syndrome

111
Q

If pt has a congenital myopathy

A

do NOT certify

(Central core disease, vent Toni lead myopathy, congenital muscular dystrophy, rod-nemaline myopathy, dermatomyositis, inclusion body myositis, polymyositis)

*if neurologist approves can consider annual. Stimulated skills test may be needed

112
Q

Metabolic muscle disease

A

Do NOT certify

113
Q

Motor neuron disease (ALS and spinal atrophy)

A

Do NOT certify

114
Q

Muscular dystrophy

A

Do NOT certify

115
Q

Neuromuscular junction disorders (Myles the is Travis and myasthenic syndrome)

A

Do NOT certify

116
Q

Peripheral neuropathy

A

Do NOT certify

117
Q

Certification after CNS tumor surgically removed

A

1yr wait if infratentorial meningioma, acoustic neuroma, pituitary adenoma, benign spinal tumor, or benign extra-axial tumor

2yr wait if spinal tumor or benign supratentorial tumor

1yr max cert

118
Q

Dementia

A

Do NOT certify

119
Q

Brain infection certification

A

1yr: bacterial meningitis or viral encephalitis without seizures
5yr: bacterial meningitis with seizure
10yr: viral encephalitis with seizures

2yr max cert

120
Q

When can a provider take a skilled performance evaluation?

A

Fixed deficit of an extremity

121
Q

Max cert for fixed deficit of extremity with SPE

A

2yr

122
Q

FMCSA defines a severe hypoglycemic reaction as

A

One that results in seizure, LOC, coma, or need or assistance by another person

123
Q

Max cert for non-insulin treated diabetes

A

2yr

Do NOT certify us driver has had on hypoglycemic episode in the last year or 2 in the last 5yrs

124
Q

When must ITDM assessment for MCSA-5870 be used?

A

Certifying driver with insulin treated diabetes

Form needs to be complete w/I 45d prior to exam by treating provider

125
Q

Max cert for insulin treated diabetes

A

1yr

ITDM for required with at least the last 3mo of preceding bs monitoring

126
Q

If insulin treated diabetic experiences a severe hypoglycemic episode

A

Prohibited from driving till treating clinician determines cause of episode has been addressed and driver has new ITDM assessment

127
Q

Max cert for mental disorders

A

Mild(1 or no meds and minimally incapacitating): 1yr

Moderate(1-2meds with complete or near complete control): 6yr

128
Q

First gen antidepressants

Amitriptyline-Evail and imipramine-Tofranil

A

Do not certify

129
Q

If driver on 2nd gen antidepressants

A

Certify for up to 1yr

130
Q

Max cert on antipsychotic

A

1yr

131
Q

Certification if pt uses anxiolytics of sedative hypnotic

A

Drug must have short/<5hr half life and used for short period of time <2wk

Max cert 2yr

132
Q

Before certifying driver with ADHD on stimulants

A

Verify diagnosis with treating provider

Max 1yr

133
Q

Narcolepsy

A

Do NOT certify

134
Q

ECT waiting period

A

6mo sx free

(Do NOT certify if pt requires maintenance ECT)

*annual medical exam required

135
Q

Lithium therapy

A

Requires annual medical exam

136
Q

Macx cert adult ADHD

A

1yr

137
Q

Mood disorder waiting period

A

6mo sx free if no psychotic depression w/o SI

1yr sx free if severe depression with SA or manic episode

138
Q

Max cert mood disorder

A

1yr

*psych eval required at least every 2yrs

139
Q

Personality max cert and requirements

A

1yr with psych eval

140
Q

Schizophrenia

A

Do NOT certify

141
Q

Waiting period for schizophreniform disorder or brief psychosis

A

6mo sx free if dx mentioned above

1yr sx free if other psychotic dx (schizoaffective & delusional disorder)

*psych eval required at least every 2yrs

NRCME (1 decks)

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