MedExaminer Flashcards
Define CMV
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
Requirement to be a commercial driver
- At least 21years old
- Read and speak English
- Capable of safely operating CMV
When must BP be confirmed with a 2nd measurement?
If >139/89
Hypertension stages
1: 140-159/90-99
2: 160-179/100-109
3: >180/110
How long can you certify a drive with history of stage 3 hypertension?
Maximum of 6 no once bp controlled <140/90
How long can you certify a driver with hx of stage 1 or 2 hypertension?
Maximum of 1yr of bp controlled <140/90
When can a 1-time 3mo certificate be given for hypertension?
- If driver has stage 2 htn
2. If driver has stage 1 htn without control <140/90
What should you do if the driver has stage 3htn?
Disqualify until bp stabilized <140/90
Required parts of UA for CMV exam
Specific gravity
Protein
Blood
Sugar
Disqualifying vision (4)
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
Federal hearing standard
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
When does an audiologist need to evaluate a driver?
If driver relies on hearing aids and fails forced whisper test
What are the 3 federal medical exemption programs?
Vision
Hearing
Epilepsy
Federal vision requirements
- Distant monocular and binocular vision of at least 20/40
- Field of vision at least 70 degrees in the horizontal meridian in wash eye
- Ability to recognize red, green, and amber
If the driver has monocular vision
This is disqualifying unless driver has a vision exemption
If peripheral vision test is inconclusive
Refer to specialist for precise measurements of peripheral vision
If a driver has monocular vision and has a federal exemption certificate how long can you certify them for?
1yr max
Even though exemption certificate is granted for 2yr
What does it mean if a pt is 49 CFR 391.64 “grandfathered”?
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
How do cataracts impact vision?
Worse glare, esp. oncoming headlights
Diminished overall visual acuity
How does glaucoma impact vision?
Peripheral vision deficits
Define aphakia
Absence of lens in the eye
How does MD impact vision?
Central vision loss
Longer recovery from bright lights
Scotoma
Disqualifying types of retinopathy
Diabetic with severe non-proliferation or proliferative diabetic retinopathy
If a driver has uncontrolled vertigo
This is disqualifying
If a driver has hx of vertigo when can you certify
At least 2mo sx free and dx of
BPPV
Or
Peripheral vestibulopathy
Disqualifying optic disease (3)
Meniere’s
Labyrinthine fistula
Nonfunctional labyrinth
How long can you certify a driver with a hearing exemption?
Up to 2yr
Initial presentation of CAD(%)
50% MI
30% angina
20% sudden death
To be certified the driver with diagnosed CAD needs
An annual exam and cardiac clearance
Acceptable echocardiogram
LVEF >39%
No pulmonary hypertension
PAP >50% of SBP
Acceptable ETT
- 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
Acute MI waiting period
2months
Acute MI max certification
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
Angina Prectoris waiting period
3mo without rest angina or change in pattern
Max cert with hx of angina
1yr
*no changes in sx in 3mo or rest angina and satisfactory biennial ett
Post-CABG waiting period
3mo
Hx CABG max cert
1yr
No orthostasis EF >39% Cardiology approval Healed sternum Annual ett
PCI waiting period
1wk
Certification w hx PCI
1yr max
Cardiac clearance and biennial ett
No injury to vascular site, ischemic ekg changes or rest angina
If pt has hx of PCI and ett testing is inconclusive what should be obtained?
Imaging stress test
ICD
Do not certify if or has ICD or ICD-pacemaker
Waiting period post pacemaker implantation
1mo if underlying dx must be sinus node dysfunction or Av block
3mo if underlying dx hypersensitive carotid sinus w syncope
Certification with pacemaker
Max 1yr with documentation of proper functioning and routine checks
SVT waiting period
1mo for Afib*, Post-isthmus ablation a flutter, Av nodal reentrant tach (including with WPW), atrial tachycardia, or junctions tach
*1mo anticoagulant also needed
SVT certification
Max 1yr
He controlled and cardiac clearance
*anticoag documents if afib
Ventricular arrhythmia waiting period
1mo if cad, RV outflow VT, or idiopathic LV VT
Ventricular arrhythmia certification
1yr max
Cardiac clearance required, LVEF >39%
Disqualifying dx: HCM, long QT, brugada
Heart failure certification
1yr max
Asx, LVEF >39%, ett satisfactory, annual cardiac clearance
Sustained V tach (30sec or more) is disqualifying
Syncope waiting period
3mo following initiation of treatment
Max certification with hx syncope
1yr
L3 nerve root impingement
Sensory deficiency in lower thigh
L4 nerve root impingement
Decreased patella reflex and sensation across knee to medial malleous
L5 impingement
Lateral leg and big toe numbness
S1 nerve impingement
Numbness of small toe and sole of foot
Decreased Achilles reflex
Certification with congenital heart disease
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
Heart transplant waiting period
1yr
Heart transplant certification
Max 6mo
Cardiac clearance Q6mo and no signs of rejection
Hypertrophic cardiomyopathy or restrictive cardiomyopathy
Do NOT certify
AAA rupture risk
<4cm is rare
<5 is 1-3% per year
5-6cm is 5-10% per year
> 7cm is approx 20% per year
AAA certification
Max 1yr
Must be <4cm and asx
Or
4-5cm with vascular clearance
Annual aaa us recommended
Post surgical aaa repair waiting period
3mo
Do NOT certify pt with aaa if…
Symptoms
Recommended surgical repair
4-5cm w/o vascular clearance
> 5cm
Hx of >0.5cm growth in 6mo period
TAA certification
If <3.5cm
Max 1yr and 3mo post surgical wait just like AAA
Max cert acute DVT
1yr with appropriate anticoag therapy
Max cert with chronic thrombotic venous dz
2yr
Max cert for intermittent claudication
1yr
Waiting period surgical repair for claudication
3mo
Max cert superficial phlebitis
2yr
PE waiting period and max cert
3mo w appropriate anticoagulant therapy
1yr
Valvular heart disease certification and surgical waiting period
Usually max cert 1yr but semi regular echo required
3mo waiting period after surgery unless balloon angioplasty then only 4wk
Anticoagulant certification
1yr max with
Stabilized on meds for at least 1mo with AF least monthly monitoring and provides copy of INR report at exam
How long should driver abstain from driving after taking 1st gen antihistamine?
12hr
Max cert with allergic rhinitis
2yr
Max cert with Hx angioedema or anaphylaxis
2yr
Max cert with asthma
2yr
Must be controlled w/o FEV1<65% or hypoxemia (PaO2 <65mmHg)
Cert with hypersensitivity pneumonitis
2yr
*can not be severe and unmanaged
COPD max cert
2yr
Can not have rest hypoxemia, chronic resp failure or continued coughing with syncope
Pulm TB certification
Max 2yr
Must not be contagious, taking med, asx, and stable lung function
(Same guidelines for atypical TB)
Certification with chest wall deformities
Max 2yr
W/o hypoxemia at rest, chronic resp failure, or constant cough or cough syncope
CF max cert
1yr with other pulm dz standards, PFTs, and specialist clearance
ILD max cert
2yr
W/o hypoxemia at rest, chronic resp failure, or constant cough or cough syncope
Special requirements for certification of hx spontaneous pneumothorax
CXR showing complete resolution
Pleurodesis if hx recurrent disease
Max cert 2yr
When should you get PFTs?
Hx any lung disease
Sx of SOB, cough, chest tightness or wheezing
PFT standards
FEV1>65%
FEV1/FVC ratio >65%
FVC >60%
When must driver have ABG analysis?
Pulse oximetry <92%
ABG standards
PaO2 not less than
65mmHg below 5000ft
60mmHg above 5000ft
PaCO2 <45mmHg at any altitude
Max cert cor pulmonale
2yr
W/o sx and satisfactory ABG
Pulm htn max cert
1yr
Epilepsy waiting period
At least 10yr off medication and seizure free
Single unprovoked seizure waiting period
5yr seizure free and off medication
Max cert for single unprovoked seizure
1yr
Neuro clearance required
Acute seizure hx due to systemic metabolic illness
Can certify for up to 2yr if underlying metabolic dysfunction has been corrected
Max cert if hx of childhood febrile seizures
2yr
Epilepsy Seizure exemption requirements
No seizure for 8yr
Stable therapy and seizure free for 2yr
Annual reports from treating physician
Annual medical exam
Duration of seizure exemption
2yr but driver still needs annual exams
Single unprovoked seizure exemption requirements
Seizure Free for at least 4yr on or off meds
Stable meds for 2yr
Single provoked seizure exemption requirements
Seizure free on or off meds for 8yr
2yr stable meds
Annual recert
Single provoked seizures- low risk factors
Caused by meds
Non-penetrating head injury with LOC <30min
Metabolic derangement
Alcohol or drug withdrawal
Single provoked seizure- high risk factors
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
Hx of brain surgery penetrating the dura
Should not certify
TBI classes
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
TBI waiting period
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
TBI max certification
1yr
Unless mild without early seizures, Then 2yr
Neurologist clearance needed
TIA waiting period and max cert
1yr and 1yr
What areas of the brain when affected by stoke hold a higher risk of seizures?
Cortical and subcritical
*cerebellum and brainstorm vascular lesions are NOT associated with an increased seizure risk
Stoke minimum waiting period
1yr if cerebellum of brain stem
5yr if cortical or subcortical
*neurologist clearance required
If driver with CVA/ICH/SAH hx is on Coumadin
Do not certify
Waiting period after intra cerebral or subarachnoid hemorrhage
1yr if cerebellum of brain stem
5yr if cortical or subcortical
*neurologist clearance required
1yr max cert
Max cert autonomic neuropathy
2yr
-resting tachycardia and orthostatic hypotension are disqualifying
Disqualifying conditions of abnormal muscle activity
Myotonia
Isaac’s syndrome
Stuff-man syndrome
If pt has a congenital myopathy
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
Metabolic muscle disease
Do NOT certify
Motor neuron disease (ALS and spinal atrophy)
Do NOT certify
Muscular dystrophy
Do NOT certify
Neuromuscular junction disorders (Myles the is Travis and myasthenic syndrome)
Do NOT certify
Peripheral neuropathy
Do NOT certify
Certification after CNS tumor surgically removed
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
Dementia
Do NOT certify
Brain infection certification
1yr: bacterial meningitis or viral encephalitis without seizures
5yr: bacterial meningitis with seizure
10yr: viral encephalitis with seizures
2yr max cert
When can a provider take a skilled performance evaluation?
Fixed deficit of an extremity
Max cert for fixed deficit of extremity with SPE
2yr
FMCSA defines a severe hypoglycemic reaction as
One that results in seizure, LOC, coma, or need or assistance by another person
Max cert for non-insulin treated diabetes
2yr
Do NOT certify us driver has had on hypoglycemic episode in the last year or 2 in the last 5yrs
When must ITDM assessment for MCSA-5870 be used?
Certifying driver with insulin treated diabetes
Form needs to be complete w/I 45d prior to exam by treating provider
Max cert for insulin treated diabetes
1yr
ITDM for required with at least the last 3mo of preceding bs monitoring
If insulin treated diabetic experiences a severe hypoglycemic episode
Prohibited from driving till treating clinician determines cause of episode has been addressed and driver has new ITDM assessment
Max cert for mental disorders
Mild(1 or no meds and minimally incapacitating): 1yr
Moderate(1-2meds with complete or near complete control): 6yr
First gen antidepressants
Amitriptyline-Evail and imipramine-Tofranil
Do not certify
If driver on 2nd gen antidepressants
Certify for up to 1yr
Max cert on antipsychotic
1yr
Certification if pt uses anxiolytics of sedative hypnotic
Drug must have short/<5hr half life and used for short period of time <2wk
Max cert 2yr
Before certifying driver with ADHD on stimulants
Verify diagnosis with treating provider
Max 1yr
Narcolepsy
Do NOT certify
ECT waiting period
6mo sx free
(Do NOT certify if pt requires maintenance ECT)
*annual medical exam required
Lithium therapy
Requires annual medical exam
Macx cert adult ADHD
1yr
Mood disorder waiting period
6mo sx free if no psychotic depression w/o SI
1yr sx free if severe depression with SA or manic episode
Max cert mood disorder
1yr
*psych eval required at least every 2yrs
Personality max cert and requirements
1yr with psych eval
Schizophrenia
Do NOT certify
Waiting period for schizophreniform disorder or brief psychosis
6mo sx free if dx mentioned above
1yr sx free if other psychotic dx (schizoaffective & delusional disorder)
*psych eval required at least every 2yrs
