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

Physical Qualification Standards and Advisory Criteria - Neurological Flashcards

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USMLE® Step 1 flashcards
1
Q

Waiting period for anticoagulant therapy

A

1 month stabilized INR

Must provide a copy of INR results and have at least monthly monitoring

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2
Q

Max certification period for a patient on anticoagulants

A

1 year

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3
Q

Recommend not to certify a driver on anticoagulants if…

A

The driver has an underlying cerebrovascular disorder

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4
Q

Can you certify a driver who is on anticonvulsant therapy?

A

Only if nature and severity of the underlying condition does not interfere with safe driving and effects of medication used while operating a CMV does not endanger the driver or the public

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5
Q

When should you disqualify a driver on anticonvulsants?

A

If the anticonvulsant meds are used to control or prevent seizures

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6
Q

The risk for subsequent unprovoked seizures is greatest when?

A

In the first 2 years following an acute brain insult

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7
Q

For the entire waiting period following seizure, the driver should be…

A

Seizure free

Off anticonvulsant meds for the control of seizures

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8
Q

When should you apply a 1 year waiting period for seizures?

A

Mild insult w/o early seizures
Stroke w/o risk for seizures
Intracerebral or subarachnoid hemorrhage w/o risk for seizures

Must be seizure free and off anticonvulsants for the entire 1 year waiting period

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9
Q

When should you apply a 2 year waiting period for seizures?

A

Moderate insult w/o early seizures
Mild insult with early seizures

Must be seizure free and off anticonvulsants for the entire 2 year waiting period

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10
Q

When should you apply a 5 year waiting period for seizures?

A

Moderate insult with early seizures
Stroke with risk for seizures
Intracerebral or subarachnoid hemorrhage with risk for seizures

Must be seizure free and off anticonvulsants for the entire 5 year waiting period

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11
Q

How long can a driver with history of seizures be certified for?

A

1 year, if:

Driver with a hx of mild or moderate insult who has:

  • Completed the min waiting period seizure free and off meds
  • Normal PE, neuro exam, and neuropsycho test
  • Clearance from a neurologist
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12
Q

For seizures caused by metabolic dysfunction, is there a specific waiting period?

A

No. Can certify for up to 2 years provided the underlying systemic metabolic dysfunction has been corrected and driver has no disqualifying risk or recurrence

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13
Q

Can a driver with childhood seizures be certified?

A

Yes, for up to 2 years, provided seizures were limited to childhood febrile seizures

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14
Q

Following an unprovoked seizure, the driver should be seizure free and off anticonvulsants for at least _____ to distinguish between a medical history of a single seizure and epilepsy.

A

5 years

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15
Q

If a driver has a second seizure following an unprovoked seizure, regardless of the elapsed time…

A

That would constitute a medical history of epilepsy and driver would no longer be eligible for certification.

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16
Q

Waiting period for drivers with history of unprovoked seizure

A

10 years off anticonvulsants and seizure free provided they have no established medical history or diagnosis of epilepsy

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17
Q

Recommend to certify a driver with a single unprovoked seizure if …

A

Completed the minimum 5 year waiting period seizure free and off anticonvulsants

Clearance by neurologist

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18
Q

Can a driver with vertigo be certified?

A

Yes, with 2 mo waiting period asymptomatic with dx of BPPV or acute or chronic peripheral vestibulopathy

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19
Q

Do not certify a driver for dizziness/vertigo if the driver has a diagnosis of…

A 
BPPV with symptoms in the last 2 mo
Acute/chronic peripheral vestibulopathy with symptoms in the last 2 mo
Meniere's disease
Labyrinthine fistula
Nonfunctioning labyrinths
20
Q

When can you apply a 1 year waiting period for CNS infections?

A

1 year seizure free and off anticonvulsants for:

Bacterial meningitis w/o early seizures
Viral encephalitis w/o early seizures

21
Q

When can you apply a 5 year waiting period for CNS infections?

A

5 years seizure free and off anticonvulsants for

Bacterial meningitis with early seizures

22
Q

When can you apply a 10 year waiting period for CNS infections?

A

10 years seizure free and off anticonvulsant meds for

Viral encephalitis with early seizures

23
Q

Does a driver with a history of aseptic meningitis require a waiting period?

A

No

24
Q

Do not certify a driver with autonomic neuropathy who has…

A

Cardiovascular autonomic neuropathy causing resting tachycardia or orthostatic BP

Other organ autonomic neuropathy that interferes with driving ability

25
Q

For drivers with abnormal muscle activity, do not certify a driver who has a diagnosis of…

A

Myotonia

Isaac’s Syndrom

Stiff-man syndrome

26
Q

Can a driver with a congenital myopathy be certified?

A

No

These include central core disease, centronuclear myopathy, congenital muscular dystrophy, rod (nemaline) myopathy

27
Q

Can a driver with a metabolic muscle disease be certified?

A

Nope

28
Q

Can a driver with a motor neuron disease be certified?

A

Nope

29
Q

How about muscular dystrophy? Can a driver with that be certified

A

NOPE

30
Q

Neuromuscular junction disease (ie myasthenia gravis)

A

They can’t drive either. It’s a damn shame.

31
Q

Peripheral neuropathy?

A

They can’t drive either

32
Q

What type of CNS tumors need a 1 year waiting period?

A 
1 year post surgical removal of...
Intratentorial meningiomas
Acoustic neuromas
Pituitary adenomas
Spinal benign tumors
Benign extra-axial tumors
33
Q

What type of CNS tumors need a 2 year waiting period?

A

2 years post surgical removal of…
Benign supratentorial tumors
Spinal tumors

34
Q

Max certification period for a driver with a CNS tumor?

A

1 year certification following 1 or 2 year waiting period after removal

Has to have stable nonprogressive deficit or no neuro deficit

Imaging must show no tumors

35
Q

Can a driver with dementia be certified?

A

Hell no

36
Q

Waiting period for embolic and thrombotic strokes

A

1 year if not at risk for seizures (cerebellum or brainstem vascular lesions)

5 years if at risk for seizures (cortical or subcortical deficits)

37
Q

Max certification for embolic/thrombotic strokes

A

1 year, provided:

  • Waiting period complete
  • Normal PE, neuro exam including neuro-ophthalmological eval and neuropsych testing
  • No neuro residuals, or if present severity that doesn’t interfere with driving
  • Clearance by a neurologist
38
Q

Waiting period following intracerebral and subarachnoid hemorrhages

A

1 year if not at risk for seizures

5 years if at risk for seizures

39
Q

Max certification following intracerebral and subarachnoid hemorrhages

A

1 year, same requires as for embolic/thrombotic strokes

40
Q

How about waiting period for TIAs?

A

Same as the other types of stroke:

1 year if not at risk for seizures

5 years if at risk for seizures

41
Q

Max certification after TIAs

A

1 year

42
Q

What is the best predictor of future risk of seizures following TBI?

A

The length of time an individual is seizure free and off anticonvulsant meds

43
Q

A waiting period of 2 years seizure free and off anticonvulsants is appropriate for what type of TBIs?

A

Moderate TBI w/o early seizures

Mild TBI with early seizures

44
Q

A waiting period of 5 years seizure free and off anticonvulsants is appropriate for what type of TBIs?

A

Moderate TBI with early seizures

45
Q

Max certification following TBI

A

1 year, unless it was a mild TBI without early seizures (that gets 2 years)

46
Q

See page 166 for a great table

A

What did I just say?!

CDL Medical Examiner exam (11 decks)

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