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DOT Exam Oakstone Course > Static Neurological Conditions > Flashcards

Static Neurological Conditions Flashcards

1
Q

What are the three standards that apply to assessment of the neurological system?

A
  1. 49 CFR 391.41 b7 - discretionary; involves rheumatic, arthritic, orthopedic, and muscular evaluation
  2. 49 CFR 391.41 b8 - nondiscretionary; pertains to epilepsy
  3. 49 CFR 391.41 b9 - discretionary; pertains to mental disorders
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2
Q

Which standard that applies to assessment of the neurological system is non-discretionary?

A

49 CFR 391.41 b8 - nondiscretionary; pertains to epilepsy

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3
Q

When is use of anticonvulsant medication disqualifying?

A

Is disqualifying the medicine is being used to treat the patient for seizures. There’s still a risk for seizures if a dose is missed.

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4
Q

When is use of anticonvulsant medication not disqualifying?

A

If the medicine is being used to treat for psychiatric disorders or chronic pain, patient is not automatically disqualified from driving. The small doses used for chronic pain are less likely to be associated with side effects that could interfere with safe driving.

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5
Q

What are some side effects of anticonvulsant drugs that could interfere with safe driving?

A

Depressed mood, cognitive deficits, decreased reflex responses, unsteadiness, sedation.

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6
Q

What three conditions have to be met in order to certify a driver who takes a medication that is an anticonvulsant?

A
  1. Medication is proven to be safe and effective for the driver
    1. Severity of the underlying condition does not interfere with safe driving
  3. the medicine is not being used to treat or control seizures
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7
Q

Name three different reasons that a driver who is prescribed an anticonvulsant cannot be certified to drive a commercial motor vehicle.

A
  1. Medication’s side effects endanger public safety
  2. severity of the underlying condition interferes with safe driving
  3. medication is being used to treat seizures
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8
Q

If it is determined that driver who takes an anticonvulsant can be certified, what is the maximum certification period?

A

Two years
The anticonvulsant must be treating something other than epilepsy(e.g. chronic pain)

get a specialty consult when indicated

driver must have an annual medical exam

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9
Q

When is a driver who takes anticoagulants ineligible for certification?

A

Do not certify the driver if the anticoagulant is being given for a cerebral vascular disorder, because of the risk of bleeding while driving.

The certification disorder is based on underlying condition, not purely on the basis of needing an anticoagulant.

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10
Q

Can a driver who was otherwise medically eligible be certified if they are taking an anticoagulant because of a cardiovascular disorder?

A

Yes. You can certify them after the patient has been treated for at least a month and is stabilized. The patient must provide INR results during the examination.

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11
Q

Name four situations when a driver who was otherwise medically eligible cannot be certified because they’re taking anticoagulation.

A
  1. Anticoagulant is for a cerebrovascular disorder
  2. INR is not monitored
  3. INR is monitored, but it’s not therapeutic
  4. underlying disease is disqualifying
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12
Q

What’s the maximum time length for which a person who is on an anticoagulant be certified?

A

Driver can be certified for up to one year
-driver must have annual medical exams and monthly INRs
-get specialty consultation with indicated

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13
Q

The DOT classifies neurological conditions into three different types. Name these types.

A

-Static
-progressive
-episodic

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14
Q

How does the DOT define a static neurologic condition?

A

-event happens and has residual, long-lasting effects
-there is a risk that the event could recur

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15
Q

How does the DOT define a progressive neurologic condition?

A

Symptoms become more severe over time

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16
Q

How does the DOT define an episodic neurologic condition?

A

Condition occurs periodically and/or repeatedly, but not continuously

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17
Q

Give examples of some static neurologic conditions.

A

-TIA with little or no residual effect
-embolic or thrombotic stroke with moderate to major residual effects
-intracerebral or subarachnoid hemorrhage
-seizure secondary to stroke
-traumatic brain injury with or without seizure
-spinal cord injury

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18
Q

When is the risk of repeat TIA or stroke the greatest?

A

-During the first few weeks following the TIA
-after a year, risk of repeat occurrence decreases to 5%; the risk can be decreased by medical or surgical treatment

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19
Q

After a driver has had a TIA or a minor stroke, what requirements must be met in order to get certified?

A

-One year waiting period during which patient is seizure free and off medication
-normal physical exam at the time the medical examiner sees them
-normal neuro- exam including neuro- ophthalmological evaluation and neuropsychological testing

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20
Q

What would make a driver who has had TIA or minor stroke ineligible for certification?

A

-Use of oral anticoagulant therapy
-any other drug or combination of drugs with high risk of complications

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21
Q

If a driver who has had TIA or minor stroke is certified, how often do you have to be examined?

A

-Must have an annual medical exam
-minimum of annual certification, although the examiner has the discretion to certify for less than a year if they have particular concerns

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22
Q

When would a driver who has had an embolic or thrombotic stroke become ineligible for certification?

A

Driver cannot be certified if there are significant deficits that interfere with:
-attention
-cognitive ability
-concentration
-judgment
-physical strength and agility
-reaction time
-vision

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23
Q

Location of the stroke is directly related to potential for seizures. Strokes involving the ______ or ________ are least like to cause poststroke seizures.

A

cerebellum
brainstem

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24
Q

Location of the stroke is directly related to potential for seizures. Strokes involving ______ or _________ deficits are at greatest risk for poster seizures.

A

cortical
subcortical

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25
Q

Some, but not all, drivers who have an embolic or thrombotic stroke can be certified. One of the requirements to certify a driver who has had embolic or thrombotic stroke after a one year waiting period?

A

-Location of the stroke is not one that is high risk for seizures (recall the strokes involving the cerebellum or brainstem are least likely to cause poststroke seizures)
-normal physical exam
-normal neurologic exam, including neuro- ophthalmological evaluation and neuropsychological test
-any residual effects of the stroke don’t interfere was driving ability
-clearance from neurologist

26
Q

Some, but not all, drivers who have an embolic or thrombotic stroke can be certified. One of the requirements to certify a driver who has had embolic or thrombotic stroke after a five year waiting period?

A

Location of the stroke is one that is high risk for seizures (recall the strokes involving cortical and subcortical deficits are high risk for poststroke seizures)
-normal physical exam
-normal neurologic exam, including neuro- ophthalmological evaluation and neuropsychological test
-any residual effects of the stroke don’t interfere was driving ability
-clearance from neurologist

27
Q

A driver has had a post stroke seizure. How long is the waiting period before the driver can be certified?

A

Five years
-during this five-year period, they cannot have any seizures at all and must not be taking any anticonvulsants

28
Q

What would cause a driver who has experienced an embolic or thrombotic stroke to be ineligible for certification?

A

Patient requires oral anticoagulant therapy
-any other drug, or combination of drugs, with high risk of complications
-residual intellectual or physical impairments that could interfere with safe commercial driving
-unable to obtain clearance from neurologist

29
Q

What kind of follow-up is required for a driver who has sustained an embolic or thrombotic stroke but was allowed to keep driving commercial motor vehicles?

A

-consultation when needed
-annual medical exam
-annual certification

30
Q

Risk of seizure after intracerebral or subarachnoid hemorrhage is associated with the location of the bleeding. Which anatomical areas are least likely to be associated with poststroke seizures?

A

Cerebellum and brainstem

Patient may need appropriate specialist evaluation to confirm location of the hemorrhage.

31
Q

Risk of seizure after intracerebral or subarachnoid hemorrhage is associated with the location of the bleeding. Which anatomical areas are most likely to be associated with poststroke seizures?

A

Cortical or subcortical deficits

Patient may need appropriate specialist evaluation to confirm location of the hemorrhage.

32
Q

What is it about traumatic brain injury that could lead a driver to become ineligible for certification?

A

TBI can cause disturbances of behavioral or emotional functioning may result in total or partial disability and/or psychological maladjustment.

Many people with TBI suffer loss of memory and reasoning ability, experience speech and/or language problems, and exhibit emotional and behavioral changes that are medically disqualifying for commercial driving.

33
Q

What is the best predictor for risk of seizures after traumatic brain injury?

A

The length of time an individual is seizure free and off anticonvulsant medication is considered the best predictor of future risk for seizures.

For the entire waiting period before being considered for certification, the driver must be both:
* Seizure free.
* Off anticonvulsant medication prescribed for control of seizure.

34
Q

What are the three classes of traumatic brain injury?

A

Severe head injury
moderate head injury
mild head injury

35
Q

Describe severe head injury.

A

-penetrates the dura and causes a loss of consciousness lasting longer than 24 hours
- high risk for unprovoked seizures, and the risk does not diminish over time
-ineligible for certification

36
Q

Describe moderate head injury.

A
  • does not penetrate the dura
    -causes a loss of consciousness lasting longer than 30 minutes, but less than 24 hours
37
Q

Describe mild head injury.

A

-No dural penetration or loss of consciousness
-lasts for fewer than 30 minutes
-make sure to distinguish between mild traumatic brain injury with or without seizures

38
Q

If more than one waiting period applies (because of multiple conditions or other comorbid diseases), examine the driver for certification after the completion of the _________ waiting period.

A

Longest

39
Q

The waiting period after traumatic brain injury is a minimum of ____ years in some circumstances, but a longer minimum of ______ years in other circumstances.

A

Two years
five years

40
Q

When is the waiting period after traumatic brain injury two years?

A

-Moderate TBI without early seizures
-Mild TBI with early seizures

In both of the above cases, the patient must be 2 years seizure free and off anticonvulsant medication.

41
Q

When is the waiting period after traumatic brain injury five years?

A

-after moderate TBI with early seizures

The driver must be 5 years seizure free and off anticonvulsant medications.

42
Q

When can you give a driver a maximum certification of two years if they have sustained traumatic brain injury?

A

-driver sustained mild traumatic brain injury without early seizures

43
Q

When can you give a driver the maximum certification of one year if they have sustained traumatic brain injury?

A

-Mild traumatic brain injury with early seizures
-moderate traumatic brain injury with or without early seizures
Recall that this question is not talking about the required duration of waiting periods. It is only talking about the ration is certification you can provide once the patient has completed the required waiting period.

44
Q

Drivers who have sustained severe traumatic brain injury cannot be certified. Drivers who have sustained mild or moderate traumatic brain injury can be certified if what conditions are met?

A
  • Completed the minimum waiting period seizure free and off anticonvulsant medication.
  • Normal physical examination, neurological examination including neuro-ophthalmological evaluation, and neuropsychological test.
  • Clearance from a neurologist who understands the functions and demands of commercial driving.
45
Q

Just to review, the minimum waiting period after traumatic brain injury is two years in some cases and five years in other cases. When is the minimum waiting period two years?

A

2 years seizure free and off anticonvulsant medication following:
* Mild TBI with early seizures
* Moderate TBI without early seizures.

46
Q

Just to review, the minimum waiting period after traumatic brain injury is two years in some cases and five years in other cases. When is the minimum waiting period 5 years?

A

5 years seizure free and off anticonvulsant medication following:
* Moderate TBI with early seizures.

47
Q

The FMCSA has a medical expert panel that has issued some guidelines about return to driving if the driver has sustained a mild traumatic brain injury but did not have any early seizures. What does the expert panel say about the waiting period for drivers who sustained mild traumatic brain injury but no early seizures?

A

Drivers who sustained mild traumatic brain injury but who did not experience loss of consciousness (LOC) as a result of their head injury could be considered eligible to return to commercial driving 30 days after the injury.

Those who sustained mild traumatic brain injury and who experienced loss of consciousness should refrain from commercial driving for 90 days to ensure that they are symptom free.

48
Q

Individuals with mild TBI should be free of what kinds of symptoms of concern before they are qualified (i.e., 30 days after injury if no LOC, 90 days after injury if LOC)?
(note: this info comes from a medical expert panel document, not from the Oakstone module)

A

Headaches
Irritability
Dizziness
Imbalance
Fatigue
Sleep disorders
Inattention
Decreased concentration and memory
Noise and light sensitivity
Thinking slowed
Difficulty recalling new material
Personality change
Difficulty starting or initiating activities
Difficulty sequencing information
Impaired attention to details
Impaired ability to benefit from experience Deficits in planning and carrying out activities

49
Q

What is severe traumatic brain injury? Why is it that drivers have had severe traumatic brain injuries cannot be certified?

A

-severe TBI penetrates the durra and causes loss of consciousness which lasts for more than 24 hours
-It is associated with a high risk for unprovoked seizures, and the risk does not decrease over time

50
Q

Describe moderate TBI.

A

-Does not penetrate durra
-causes loss of consciousness that lasts more than 30 minutes but less than 24 hours
-for DOT purposes, you describe moderate TBI as occurring either without early seizures or with early seizures

51
Q

After moderate TBI, the waiting period is either two years or five years. Which kind of moderate TBI requires a two year waiting period?

A

-Moderate TBI without early seizures

52
Q

What requirements must be met in order for a patient who has sustained MODERATE TBI without early seizures to obtain certification?

A

-Complete a two-year seizure free waiting period; during this time, they must also be off anticonvulsants
-clearance from neurologist
-pass physical exam

If the driver fails to meet all three of these criteria, you cannot certify them.
Driver must have an annual medical exam, yearly recertification, and specialty consult when indicated.

53
Q

After moderate TBI, the waiting period is either two years or five years. Which kind of moderate TBI requires a five year waiting period?

A

Moderate TBI with early seizures

54
Q

What requirements must be met in order for a patient who has sustained MODERATE TBI with early seizures to obtain certification?

A

-Complete a five-year seizure free waiting period; during this time, they must also be off anticonvulsants
-clearance from neurologist
-pass physical exam

If the driver fails to meet all three of these criteria, you cannot certify them.
Driver must have an annual medical exam, yearly recertification, and specialty consult when indicated.

55
Q

What requirements must patient who sustained MILD traumatic brain injury with early seizures meet in order to be certified?

A

-Two year waiting period during which they must be seizure free and off anticonvulsants the entire time
-pass physical exam
-clearance from neurologist

56
Q

What requirements must patient who sustained MILD traumatic brain injury with early seizures meet in order to remain certified?

A

-Must have annual medical exam and yearly recertification
-specialists consult when needed

57
Q

How frequently may a patient who sustained MILD traumatic brain injury without early seizures recertify?

A

-Recertify every two years in the patient who had mild TBI without early seizures

58
Q

Spinal cord injury accompanied by _____________ is always disqualifying.

A

Paraplegia

Determine if any residual deficits due to spinal cord injury would interfere with safe driving before you attempt to recertify the driver who has sustained any kind of spinal cord injury.

59
Q

A driver with a current clinical diagnosis of ______ must be disqualified.

A

Epilepsy

also, a driver who is taking medication for control or prevention of seizures, or whose medications cause side effects that interfere with safe driving, must be disqualified.

60
Q

It is recommended to disqualify drivers with certain neurologic conditions/diagnoses. Name them.

A

Severe traumatic brain injury
AV malformation or aneurysm that has not been surgically repaired
Dementia
Parkinson’s disease
iatrogenic Parkinsonism (drug-induced)
cerebellar ataxia of any etiology
frequent or severe headaches that interfere with safe driving

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