Vascular Disease Flashcards
Peripheral vascular disease has benign course with little risk for sudden incapacitation. Nonetheless, some drivers with peripheral vascular disease are disqualified. Why would they be disqualified?
drivers who have pain at rest have a significant amount of ischemia
-pain at rest is disqualifying because the ischemia means they may have reduced dexterity of the affected limb
-drivers with peripheral vascular disease often also have other disqualifying cardiovascular disease
Under what circumstances can a driver with peripheral vascular disease become certified?
-At least three months postsurgical
-no pain at rest
-no disqualifying cardiovascular disease
What is the required waiting period if a driver with peripheral vascular disease has surgery?
Must be at least three months postsurgery
Under what circumstances can a driver with peripheral vascular disease become recertified?
-Annual recertification
-annual medical exam
-additional testing consultations as needed
7 to 9% of people with peripheral vascular disease develop intermittent claudication. Intermittent claudication is the primary symptom of what?
-It’s the primary symptom of obstructive vascular disease of the lower extremities
-if the arterial insufficiency is severe enough, tissue necrosis, neuropathy, and atrophy of muscle may occur
When is a patient who has intermittent claudication eligible for certification?
-Must be at least three months postsurgical with relief of symptoms
-no disqualifying cardiovascular disease
What are three complications of intermittent claudication?
-necrosis
-neuropathy
-atrophy
When a patient who has intermittent claudication has surgery, what is the waiting period before the driver can be considered for certification?
At least three months
How frequently must a driver with intermittent claudication be recertified?
-Annual recertification
-annual medical exam
Name two reasons for disqualifying a driver with intermittent claudication.
-pain at rest
-presence of other disqualifying cardiovascular disease
At what interval can a driver with intermittent claudication be recertified?
-Must recertify annually
-must have annual medical exam
-additional tests or consultations as needed
What are complications of varicose veins?
-Chronic venous insufficiency
-leg ulcerations
-recurrent deep vein thrombosis
Under what circumstances can a driver with varicose veins be certified?
-After etiology is confirmed
-treatment shown to be safe and effective
-no complications
Under what circumstances is a driver with varicose veins ineligible for certification?
-If you believe, as a medical examiner, the course and severity of the disease poses a risk to the driver and public safety
If a driver has varicose veins and is certified, how often must they be recertified? How often must they get a medical exam?
-Biennial recertification and medical exam
-additional tests in consultation as needed
Why drivers at risk for DVTs, and what is the feared complication that can happen next?
-There at risk for DVT because of long hours sitting.
-DVT can result in pulmonary emboli, then sudden incapacitation or death
When is a driver with DVT eligible for certification?
Certify when the following conditions are met:
-after etiology is confirmed
-no complications
-no residual acute DVT
-treatment is safe and effective
How often must a driver with DVT be recertified?
-Annual recertification and annual medical exam
-additional tests or consultations as needed
-if driver is being treated with anticoagulants, must meet INR monthly monitoring guidelines
When is a driver who has a DVT ineligible for certification?
-ineligible until the DVT is adequately treated
What is superficial phlebitis?
-It’s inflammation of the veins
-superficial phlebitis itself is benign self-limiting, but often coexists with DVT, which is a whole lot less benign
-if driver has superficial phlebitis, you must exclude DVT
When is a driver who has superficial phlebitis eligible for certification?
-After etiology is confirmed
-treatment shown to be safe and effective
-no complications
Explain when you would not certify a driver with superficial phlebitis.
Coexisting DVT and does not meet the DVT guidelines-
How often does a driver who has superficial phlebitis need to be recertified?
-Biennial recertification
-biennial medical exam
-additional tests or consultations as needed
What is important about chronic thrombotic venous disease?
-Increases the risk pulmonary emboli
-evaluate on a case-by-case basis
Under what conditions is a driver who has chronic thrombotic venous disease eligible for certification?
-Asymptomatic
-etiology has been confirmed
-treatment shown to be safe and effective
Explain when you would not certify a driver with chronic thrombotic venous disease.
-Don’t certify if, as a medical examiner, you believe the course and severity pose a risk to the driver and to public safety.
Explain when you would not certify a driver with chronic thrombotic venous disease.
-Biennial certification and medical exam
-tests or consultations as needed
-when treated with anticoagulants, meets monitoring guidelines
Explain the major risk factor for pulmonary embolism.
Major cause of PE is history of DVT
-PE can block oxygen exchange, cause sudden incapacitation, and is associated with significant morbidity and mortality
When is a driver who has pulmonary embolism eligible for certification?
asymptomatic
-at least 3 months post PE with no recurrent PE
-on appropriate long term treatment
-no disqualifying cardiovascular dz
What is the required waiting period after a driver has had a PE?
3 months
When would you not certify a driver with pulmonary embolism?
symptomatic
-has disqualifying cardiovascular dz
How often must a driver with PE be recertified
-Annual recertification and annual medical exam
-if driver is being treated with anticoagulants, must meet INR monthly monitoring guidelines
