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CDL Medical Examiner exam > Physical Qualification Standards and Advisory Criteria - Cardiovascular > Flashcards

Physical Qualification Standards and Advisory Criteria - Cardiovascular Flashcards

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USMLE® Step 1 flashcards
1
Q

Examination requirements

A

Does the driver have:
Murmurs, extra heart sounds, arrhythmias, an enlarged heart, abnormal pulse/amplitude, carotid or arterial bruits, or varicose veins

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2
Q

What is the minimum waiting period after starting anticoagulant therapy?

A

1 month stabilized
(If more than one waiting period applies bc of multiple conditions, examine the driver for certification after the completion of the longest waiting period)

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3
Q

Maximum certification period for drivers on anticoagulant therapy

A

1 year if stabilized on medication for at least a month, provides a copy of the INR results at exam and has monthly INR monitoring

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4
Q

Do not certify a driver on anticoagulant therapy if…

A

INR is not being monitored

INR is not therapeutic

Underlying disease is disqualifying

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5
Q

How often should drivers on anticoagulants have INR monitored

A

At least monthly

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6
Q

____ is the most serious complication of an abdominal aortic aneurysm and is related to _____.

A

Rupture

Size of the aneurysm

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7
Q

____ is the primary symptom of peripheral vascular disease of the lower extremities

A

Intermittent claudication

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8
Q

The majority of AAAs occur in the _____ decades of life and occur more frequently in _____.

A

Sixth and Seventh

Males > Female (3:1)

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9
Q

An AAA:

  • Less than ____ rarely ruptures
  • Smaller than 5cm has a ____ per year rate of rupture
  • 5cm to 6cm has a ____ per year rate of rupture
  • > 7cm has approx a ___ per year rate of rupture
A

Less than 4cm rarely

<5cm - 1% to 3%

5cm-6cm - 5% to 10%

> 7cm - 20%

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10
Q

A driver with a AAA may be certified if…

A

AAA is <4cm and asymptomatic

AAA is >4cm but less than 5cm, asymptomatic, and driver has clearance from a CV specialist

AAA has been surgically repaired and driver meets post-surgical repair of aneurysm guidelines

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11
Q

What is the waiting period after surgical repair of AAAs?

A

3 months

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12
Q

A driver with a AAA must be disqualified if …

A

Driver has symptoms, regardless of size of AAA

If driver has recommendation for surgical repair from a CV specialist

AAA is between 4-5cm without clearance from CV specialist

AAA is >5 cm

AAA has increased more than 0.5cm in 6 months

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13
Q

What modality is used for monitoring AAAs?

A

Ultrasound

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14
Q

How often should a driver with a AAA have a medical exam?

A

AAA

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15
Q

What is the waiting period for DVTs?

A

No recommended time frame, but you should not certify until etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.

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16
Q

Maximum certification period for DVTs

A

1 year, if no residual acute DVT

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17
Q

Maximum certification period for driver with chronic thrombotic venous disease

A

2 years if driver has no symptoms

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18
Q

Waiting period for drivers with intermittent claudication

A

3 months post-surgical repair

Should not certify the driver until etiology is confirmed and treatment has been shown to be adequate/effective, safe and stable

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19
Q

Maximum certification period for driver with intermittent claudication

A

1 year, if after surgery, driver has relief of symptoms and no other disqualifying cardiovascular disease

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20
Q

What is the waiting period after a PE?

A

3 months with no PE

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21
Q

Maximum certification period for a driver who has had a PE?

A

1 year

If appropriate long-term treatment and no other disqualifying cardiovascular disease

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22
Q

Although superficial phlebitis is a benign and self-limited disease, _____ is often a coexisting condition and needs to be excluded during the course of the examination

A

DVT

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23
Q

Maximum certification period for superficial phlebitis?

A

2 year provided driver is otherwise qualified

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24
Q

Waiting period for thoracic aneurysm?

A

3 months post surgical repair

25
Q

Maximum certification period for thoracic aneurysm

A

1 year if…

  • Thoracic aneurysm is <3.5cm
  • Has a surgically repaired thoracic aneurysm and the driver meets post-surgical repair of aneurysm guidelines
26
Q

Can a driver with varicose veins be certified?

A

Yes, for up to 2 years if driver has no complications and etiology is confirmed

27
Q

Can a driver with an implantable cardioverter-defibrillator (ICD) be certified?

A

NO

Applies to both ICDs and combined ICD/pacemaker devices

28
Q

What is the waiting period after pacemaker implantation?

A

1 month, if the underlying disease is sinus node dysfunction, AV block

3 months, if the underlying disease is neurocardiogenic syncope or hypersensitive carotid sinus with syncope

29
Q

Maximum certification period for a driver with a pacemaker

A

1 year

30
Q

A driver with a pacemaker may be certified if

A

Documentation indicating the presence of a functioning pacemaker

Documentation indicating completion of routine pacemaker checks

No disqualifying underlying disease

31
Q

What is the minimum waiting period for arrhythmias?

A

1 month for

  • Afib (adequately anticoagulated)
  • atrial flutter (ablated)
  • AV nodal reentrant tachycardia
  • Wolff-Parkinson-White
  • Atrial tachycardia
  • Junctional tachycardia
32
Q

Max certification period for supraventricular arrhythmias

A

1 year

33
Q

To be certified with a supraventricular arrhythmia, a driver must have…

A

HR controlled
Treatment for prevention of emboli that is effective and tolerated
No underlying disease that is disqualifying
Clearance from a CV specialist

34
Q

May not certify a driver with a supraventricular arrhythmia if …

A

Loss of consciousness
Compromised cerebral function
Sudden death resuscitation

35
Q

What is the waiting period for ventricular arrhythmias?

A

1 month after drug or other therapy IF diagnosis is:

  • Coronary heart disease
  • Right ventricular outflow VT
  • Idiopathic left ventricular VT
36
Q

Maximum certification for driver with ventricular tachycardia after 1 month waiting period?

A

1 year if driver is asymptomatic, has an identified non-disqualifying cardiac cause, and has clearance from cardiology

37
Q

Do not certify a driver with ventricular arrhythmia if…

A
  • Symptomatic
  • Has NSVT, LVEF less than 40%
  • Diagnosis of HCM, Long QT, Brugada syndrome.
38
Q

What is the cut off LVEF to be certified?

A

40%, with no pulmonary hypertension

39
Q

Criteria for passing an exercise tolerance test?

A
  • Exercise to a workload capacity >6 METs
  • Attain HR >= 85% of predicted max
  • Rise in systolic BP >=20mmHg without angina
  • No significant ST segment depression
40
Q

Waiting period after MI

A

2 months

41
Q

Maximum certification period after MI

A

1 year if:

  • Asymptomatic
  • Tolerating meds
  • Satisfactory ETT
  • Resting LVER > 40%
  • No ECG ischemic changes
42
Q

Do not certify driver with recent MI if…

A

Rest angina or change in angina pattern after 3 mo of examination

Ischemic changes on rest ECG

Intolerance to cardiovascular therapy

43
Q

How should a driver with recent MI be monitored?

A

Clearance form CV specialist

Biennial ETT

44
Q

Max certification period for driver with stable angina

A

1 year if:

  • Stable angina
  • Asymptomatic
  • Tolerates meds
  • Satisfactory ETT
45
Q

Do not certify a driver with history of angina if….

A

The driver has had unstable angina within 3 mo of examination

46
Q

Waiting period after CABG

A

3 mo

Regardless of type of CABG

47
Q

Maximum certification period after CABG

A

1 year if:

  • Asymptomatic
  • Tolerates CV meds with no orthostatic sx
  • LVEF >40%
  • Clearance from cardio
  • Healed sternum
48
Q

What f/u does a driver with CABG need?

A

Annual ETT
Imaging stress test if indicated
Annual medical exam

49
Q

Waiting period after PCI

A

1 week

50
Q

Max certification period after PCI

A

1 year

51
Q

A driver with a congenital cardiac anomaly can only be certified if…

A

Asymptomatic
Mild tricuspid anomaly
Mild cardiac enlargement
Mild right ventricular dysfunction

Needs annual CV eval and echo

52
Q

Waiting period after heart transplant

A

1 year

53
Q

Maximum certification period for drivers with heart transplant

A

6 months, if…

  • Asymptomatic
  • Tolerating meds
  • Clearance from cardio
  • No signs of rejection
  • Meets all other qualification requirements
54
Q

If you note an enlarged heart in a driver, you should…

A

No certify driver until eval by a cv specialist to confirm or r/o dx of HCM or RCM

HCM and RCM are both disqualifying

55
Q

Waiting period post aortic valve repair

A

3 months

56
Q

Max certification period for aortic valve dysfunction

A

6 mo if not surgically repaired

1 year if post-aortic valve repair

57
Q

Max waiting period after aortic valve replacement

A

3 mo post surgery

58
Q

Max certification period after aortic valve replacement

A

1 year

59
Q

Do not certify a driver with valvular disease if…

A

Angina

Heart failure

A fib

LVEF <50%

Thromboembolism

CDL Medical Examiner exam (11 decks)

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