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Rad Fund Unit 1 > RME Exam > Flashcards

RME Exam Flashcards

1
Q

State the purpose of the Ionizing Radiation Medical Examination (RME)

A
  1. Focused ME to establish whether or not cancer is present, which would medically DQ a person from radiation exposure.
  2. Independent exam documented on NAVMED 6470/13.
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2
Q

State the Four different types of RMEs.

A 
PE: Pre-placement exam
RE: Re-examination
SE: Situational Examination
TE: Termination Examination.
Write these names out.
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3
Q

Describe who may conduct the RME.

A

Physicians, NPs, and PAs with BUMED approved training.

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4
Q

Who may sign as the reviewer?

A

Physicians: RHI, RAM, UMO Only.

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5
Q

List the components of the RME.

A

Medical History
Special Studies
Physical Examination

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6
Q

List the special studies associated with an RME.

A

WBC, HCT, UA via dipstick or microscopic HPF within 3 months prior to the conduct of the PE.
Manual Clinical Breast Exam for Females 40+
DRE for males 40+.
Additional Studies as required.

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7
Q

Who can perform a female military member’s clinical breast exam? Civilian member?

A

Military: The RME examiner ONLY.
Civilian: Can elect for civilian provider and submit to Navy Examiner. If done by civilian, rule is 1 year.

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8
Q

Who can perform a male military member’s DRE? Civilian Member?

A

For Both, it can be the private physician or you. If done by civilian, rule is 1 year.

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9
Q

State how health record jackets or employee medical files must be marked with respect to the RME.

A

The front of the Health Record Jacket must say “Termination Radiation Medical Examination Required.”

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10
Q

Describe when a PE is required to be conducted.

A
  1. Individuals being considered for assignment as Radiation Workers prior to assignment.
  2. Personnel being considered for re-entry that have received a TE.
  3. Personnel not previously required to have a PE, but who exceeded 500 mrem in a calendar year.
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11
Q

Describe when an RE is required to be conducted.

A 
Every 5 years up to age 50.
Every 2 years from 50-60.
Annually after age 60.
Must be performed no later than 1 month following:
1. The anniversary of the previous RME
2. The 52nd Birthday
3. The 61st Birthday
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12
Q

What block on the 6470/13 is the date of the next required RME based upon?

A

In the Trainee Guide, it says Block 23 - the Reviewing Physician’s Signature.

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13
Q

When can an RE be done early?

A
  1. To ease examination workload.
  2. To combine the RE with another exam.
  3. When constrained by ship operating schedules.
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14
Q

Describe when an SE is required to be conducted.

A
  1. Any individual has exceeded radiation protection standards for radiation workers as stated in the P-5055.
  2. When an individual has ingested/inhaled a quantity of radioactive material exceeding 50% of the ALI.
  3. When Deemed necessary by a responsible attending physician.
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15
Q

What must be done in conjunction with any SE performed?

A

A REAB must be submitted.

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16
Q

Describe when a TE is required to be conducted.

A

A. Upon separation, termination of AD or employment, if they:

  1. received a PE AND
  2. have a documented occupational exposure to included 0.000 rem.

B. Also when permanently removed from duties as a radiation worker.

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17
Q

When should a TE be completed.

A

No earlier than 6 months prior to termination of duties, and as near as practical to termination.

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18
Q

Discuss the consideration of other medical exams at the time of the RME.

A
  1. Consider other exams, consults that may affect continued qualification.
  2. Patients may submit medical information from private physicians for completion of 6470/13 as well as required information related to diagnosis, treatment, continued presence of cancer.
  3. Information from other sources (Private physicians, specialty consults, diagnostics) must be completed within 45 days of the RME being started.
  4. Failure to comply may result in removal of medical qualification.
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19
Q

Define Cancer

A

A term for diseases in which abnormal cells divide without control and aggressively migrate or are transported to other organs in the host.

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20
Q

Define Tumor.

A

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. They may be benign or malignant. Also called neoplasm.

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21
Q

Define Malignant.

A

Cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body.

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22
Q

Define Benign.

A

Not cancerous. Benign tumors may grow larger but do not spread to other parts of the body. They can cause damage and/or death for the host.

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23
Q

Define Hyperplasia.

A

An abnormal increase in the number of cells in an organ or tissue.

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24
Q

Define Neoplasia.

A

Abnormal and uncontrolled cell growth that alters normal functions of host tissue, physiology, or function. A neoplasm may be benign or malignant.

25
Q

Define Hematuria.

A

The present of RBCs or blood in the urine equal or greater than 3 RBC/hpf that persist upon repeat testing.

26
Q

Define Anemia.

A

A medical condition in which the body does not have enough healthy red blood cells.

27
Q

Define Complete Blood Cell Count (CBC).

A

Lab test for WBC, RBC, PLT, HgB, HCT ad other cellular elements in blood.

28
Q

Define White Blood Cell count (WBC)

A

Lab test to determine the number of WBCs in the blood, expressed as WBC/mm^3.

29
Q

Define Hematocrit (HCT).

A

Measures the percentage of the volume of whole blood that is made up of Red Blood Cells (RBCs).

30
Q

Define Urinalysis (UA).

A

Physical, chemical, and microscopic examination of urine.

31
Q

Define Bioassay.

A

The measurement of amount or concentration of radionuclide material in the body or in biological material excreted or removed from the body and analyzed for the purposes of estimating the quantity of radionuclide in the body.

32
Q

Describe medical conditions that may be disqualifying on the radiation medical exam.

A
  1. History of cancer or of cancer therapy.
  2. History of Radiation Therapy
  3. History of Polycythemia Vera
  4. History of Leukemia
  5. Open Lesions or Wounds.
  6. Persistently abnormal WBC, HCT, UA that are or could be related to cancer.
  7. Internally deposited radionuclides greater than 50% of an ALI in 1 year.
33
Q

How should AK’s be treated on an RME?

A

They are a temporary DQ; should be treated and documented as “removed and visually verified.”

34
Q

How should BCC be treated on RME?

A

They are a Temporary DQ; should be removed, and pathology of some sort must be included, including a report of “clear margins.”

35
Q

How should colon polyps be treated on an RME?

A

They are not disqualifying, but a report from the colonoscopy must be included. Patient may remain qualified pending receipt of pathology report within 45 day requirement.

36
Q

What do you do for a WBC that is out of range?

A

Repeat with differential.
If persistently abnormal, further clinical evaluation must be conducted, in order to rule out cancer and/or bone marrow suppression.

37
Q

If a UA has a positive dipstick, what should you do?

A

You need to have 2 negative microscopic UAs in order to avoid specialty referral.

38
Q

If a UA has a positive dipstick and a negative micro, what should you do?

A

Repeat 1 further micro; if negative, patient is good; if positive, you must refer.

39
Q

If your first test is a microscopy without dipstick and it is positive, how many repeats should you do to clear the patient.

A

Only one subsequent UA is required.

40
Q

What two things should be included at the end of any comment in Block 14 (summary of abnormal findings)?

A
  1. Yes/No indication of cancer/bone marrow suppression

2. NCD/ CD

41
Q

What are the 5 things you should document in Block 14.

A
  1. Any/All Abnormal findings.
  2. Repeat Labs
  3. Non-completion of an RME.
  4. Correction of a Deficient Exam.
  5. Administrative corrections as needed for adequate space.
42
Q

If an RME is found deficient/lacking, what should be done?

A
  1. Appropriate clinical studies/ procedures will be performed to satisfy the missing requirements.
  2. This information will be added to the deficient exam in block 14.
  3. Lab studies from previous exams may be transcribed if within the 3 months prior to the exam.
  4. The form will be signed and dated by the reviewing physician.
  5. This will include “no significant interval history noted since the examination completed DDMMMYYYY. PQ for Ionizing Radiation.”
43
Q

If there is an administrative correction on an RME, what should you do.

A 
Single line through the entry.
Add the correct entry
Initial and date the change.
OR, add a note into Block 14.
Note, once Block 23 is signed, this must be a note in block 14 as a correction (deficient exam).
44
Q

Where should the 6470/13 be located in the health record of a member?

A

On top of other physical exams in section 3 of the health record.
Other associated documentation should be in their correct locations.
- Lab/path in section 4
- radiobioassays in section 1
- consultation in section 2

45
Q

What is the purpose of the REAB?

A

Established to render determinations relative to the effects of radiation as an authority established by the SG of the navy. It must provide determination and consultation on:

  • the evaluation of the relationship between alleged and actual radiation exposure and a member’s disease.
  • Determination of PQ standards for occupational radiation exposure.
  • Determination if an individual meets the standards for exposure to ionizing/non-ionizing radiation.
  • Determining potential biomedical effects, dosimetry, and methods of treatment of radiation injury.
46
Q

Who sits on the REAB?

A

Director Undersea Medicine and Radiation Health Division (Chair)
Deputy Head, Undersea Medicine
Head Radiation Health Branch
Head, Non-ionizing radiation.

47
Q

List the reporting requirements (things you are required to report) to the REAB.

A
  1. Finding cancer.
  2. History of ionizing radiation > allowed by P -5055
  3. History of/ongoing cancer therapy.
  4. An intake in excess of 50% ALI of radioactive material not intentionally administered.
  5. A description of the analysis technique must be included.
  6. Any medical condition or exam that the responsible physician, commander, CO, or OIC recommends for Chief, BUMED Review.
  7. All SEs.
  8. Allegations or claims by a service member/imployee that higher physical condition was caused by exposure to ionizing radiation.
  9. Any finding of NPQ on an RME.
48
Q

List the required items to be submitted to the REAB.

A

A Summary Letter including:
1. Reason for submission and, if appropriate, the current/DQ diagnosis.
2. The total lifetime exposure of the individual.
3. Summary of the individuals duties.
4. The disqualifying condition.
5. An outline of the key elements of the medical findings.
6. A recommendation for a finding of PQ/NPQ and the basis for the finding.
Also the most recent RME, supporting documentation related to the medical condition.

49
Q

What two blocks should be left blank if a member is marked NPQ.

A 
Block 20b (REAB findings)
Block 23 (Reviewing physician signature).
50
Q

Where should the REAB package be filed in the medical record?

A

On TOP of the RME in Section 3.

51
Q

If a previously NPQ member from a REAB wishes to undergo re-evaluation for nuclear field duty by the REAB, what must be included in the package?

A
  1. A current RME following completion of all therapy.
  2. Supporting Medical documentation, including conclusions by the treating physician, that the individual has no evidence of residual cancer.
  3. Discussion of the medical procedures/pathology reports supporting the conclusion above.
  4. Treating plan to ensure no recurrence of cancer.
  5. The plan to track the member to ensure the prescribed plan is followed.
52
Q

What are the general focuses of the NFD?

A

Hearing, Visual acuity, mental/psychological fitness, and reliability.

53
Q

What reference is used for NFDs?

A

The MANMED P117 chapter 15-103.

54
Q

What forms do we use for NFDs?

A

2808, 2807.

55
Q

If a patient misses >7 days of work due to a medical illness, what must happen next?

A

A repeat NFD must be done.

56
Q

Who can do a nuclear field duty PE?

A

Any physician, PA, or NP can do the exam; if the provider is not a UMO or RAM, it must be reviewed and undersigned by one of those two individuals.

57
Q

If you have a positive dipstick and you have a positive reflex microscopy, what should you do next?

A

In order to clear the patient, you can order 2 further micros; if either is abnormal, you must refer. You consider the dip+reflex 1 sample, not 2 separate tests.

58
Q

What is the DINA list?

A

Dosimetry Issue Not Allowed; you get put on this list if the member does not follow up within 45 days of labs or is DQ’d.

Rad Fund Unit 1 (10 decks)

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