Physical Qualification Standards and Advisory Criteria - Pulmonary

Question 1

For drivers on antihistamines, they should abstain from medication for ____ prior to operation of a vehicle

Answer 1

12 hours

Question 2

When should you disqualify a driver with asthma?

Answer 2

• Continued, uncontrolled, symptomatic asthma

- Significant impairment of pulmonary function (FEV1 <65%) and significant hypoxemia (PaO2 < 65mmHg)

Question 3

Immune-mediated granulomatous interstitial pneumonitis that may present as an acute recurrent, subacute, or chronic illness variously manifested by dyspnea, cough, and fever.

Answer 3

Hypersensitivity Pneumonitis

Question 4

Is hypersensitivity pneumonitis a disqualifying condition?

Answer 4

Not unless the etiology is unclear or treatment has not been effective and well tolerated

Question 5

How long can a driver with COPD be certified for?

Answer 5

up to 2 years

Question 6

When should you disqualify a driver with COPD?

Answer 6

Hypoxemia at rest

Chronic respiratory failure

History of continuing cough with cough syncope

Question 7

Can you certify a driver who has Atypical TB?

Answer 7

Yes, if disease remains relatively stable and the driver has normal lung function and tolerates the medical regimen

Certification up to 2 years

Question 8

If a driver has Pulmonary Tuberculosis, can you certify them?

Answer 8

Not until the driver is determined not to be contagious, etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.

Certification up to 2 year

Question 9

Can you certify a driver with a chest wall deformity (ie Kyphosis, kyphoscoliosis, pectus excavatum, ankylosing spondylitis, massive obesity, recent surgery)

Answer 9

Yes, provided they have no hypoxemia at rest, no chronic respiratory failure, no hx of continuing cough with cough syncope

Question 10

Is there a waiting period before a driver with history of pneumothorax can be certified?

Answer 10

No but you should ensure complete recovery using CXR. If there is air in the pleural space or mediastinum, additional time away is indicated.

Question 11

What are the parameters for certifying a driver with past pneumothorax?

Answer 11

Asymptomatic w/o chest pain or SOB
No disqualifying underlying lung disease
Confirmed resolution of the single spontaneous pneumothorax
Successful pleurodesis and meets acceptable pulmonary parameters

Question 12

Who should not be certified after a pneumo?

Answer 12

Has not met certification parameters
Hx of two or more spontaneous pneumothoraces on one side if no successful surgical procedure has been done to prevent recurrenece
Hypoxemia at rest
Chronic respiratory failure
Hx of continuing cough with cough syncope

Question 13

Indicators for obtaining pulmonary function tests

Answer 13

Hx of any specific lung disease
Symptoms of SOB, cough, chest tightness, wheezing
Cigarette smoking in drivers 35 years or older

Question 14

When should you get Screening Pulse Oximetry iand/or ABGs?

Answer 14

PFTs with FEV1 less than 65% of predicted value

FEV1/FVC ratio less than 65%

Restrictive impairment present and FVC is <60%

Question 15

If oximetry is less than ____, the driver must have an ABG

Answer 15

92%

Question 16

Recommend not to certify the driver when ABG measurements reveal:

Answer 16

PaO2 <65mmHg at altitudes below 5000ft
PaO2 <60mmHg at altitudes >5000ft
PaCO2 >45mmHg at any altitude

Question 17

Maximum certification for pulmonary htn

Answer 17

1 year, so long as patient has no dyspnea at rest, dizziness, hypotension, PaO2<65mmHg