Vascular Disease

Question 1

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?

Answer 1

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

Question 2

Under what circumstances can a driver with peripheral vascular disease become certified?

Answer 2

-At least three months postsurgical
-no pain at rest
-no disqualifying cardiovascular disease

Question 3

What is the required waiting period if a driver with peripheral vascular disease has surgery?

Answer 3

Must be at least three months postsurgery

Question 4

Under what circumstances can a driver with peripheral vascular disease become recertified?

Answer 4

-Annual recertification
-annual medical exam
-additional testing consultations as needed

Question 5

7 to 9% of people with peripheral vascular disease develop intermittent claudication. Intermittent claudication is the primary symptom of what?

Answer 5

-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

Question 6

When is a patient who has intermittent claudication eligible for certification?

Answer 6

-Must be at least three months postsurgical with relief of symptoms
-no disqualifying cardiovascular disease

Question 7

What are three complications of intermittent claudication?

Answer 7

-necrosis
-neuropathy
-atrophy

Question 8

When a patient who has intermittent claudication has surgery, what is the waiting period before the driver can be considered for certification?

Answer 8

At least three months

Question 9

How frequently must a driver with intermittent claudication be recertified?

Answer 9

-Annual recertification
-annual medical exam

Question 10

Name two reasons for disqualifying a driver with intermittent claudication.

Answer 10

-pain at rest
-presence of other disqualifying cardiovascular disease

Question 11

At what interval can a driver with intermittent claudication be recertified?

Answer 11

-Must recertify annually
-must have annual medical exam
-additional tests or consultations as needed

Question 12

What are complications of varicose veins?

Answer 12

-Chronic venous insufficiency
-leg ulcerations
-recurrent deep vein thrombosis

Question 13

Under what circumstances can a driver with varicose veins be certified?

Answer 13

-After etiology is confirmed
-treatment shown to be safe and effective
-no complications

Question 14

Under what circumstances is a driver with varicose veins ineligible for certification?

Answer 14

-If you believe, as a medical examiner, the course and severity of the disease poses a risk to the driver and public safety

Question 15

If a driver has varicose veins and is certified, how often must they be recertified? How often must they get a medical exam?

Answer 15

-Biennial recertification and medical exam
-additional tests in consultation as needed

Question 16

Why drivers at risk for DVTs, and what is the feared complication that can happen next?

Answer 16

-There at risk for DVT because of long hours sitting.
-DVT can result in pulmonary emboli, then sudden incapacitation or death

Question 17

When is a driver with DVT eligible for certification?

Answer 17

Certify when the following conditions are met:
-after etiology is confirmed
-no complications
-no residual acute DVT
-treatment is safe and effective

Question 18

How often must a driver with DVT be recertified?

Answer 18

-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

Question 19

When is a driver who has a DVT ineligible for certification?

Answer 19

-ineligible until the DVT is adequately treated

Question 20

What is superficial phlebitis?

Answer 20

-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

Question 21

When is a driver who has superficial phlebitis eligible for certification?

Answer 21

-After etiology is confirmed
-treatment shown to be safe and effective
-no complications

Question 22

Explain when you would not certify a driver with superficial phlebitis.

Answer 22

Coexisting DVT and does not meet the DVT guidelines-

Question 23

How often does a driver who has superficial phlebitis need to be recertified?

Answer 23

-Biennial recertification
-biennial medical exam
-additional tests or consultations as needed

Question 24

What is important about chronic thrombotic venous disease?

Answer 24

-Increases the risk pulmonary emboli
-evaluate on a case-by-case basis

Question 25

Under what conditions is a driver who has chronic thrombotic venous disease eligible for certification?

Answer 25

-Asymptomatic
-etiology has been confirmed
-treatment shown to be safe and effective

Question 26

Explain when you would not certify a driver with chronic thrombotic venous disease.

Answer 26

-Don’t certify if, as a medical examiner, you believe the course and severity pose a risk to the driver and to public safety.

Question 27

Explain when you would not certify a driver with chronic thrombotic venous disease.

Answer 27

-Biennial certification and medical exam
-tests or consultations as needed
-when treated with anticoagulants, meets monitoring guidelines

Question 28

Explain the major risk factor for pulmonary embolism.

Answer 28

Major cause of PE is history of DVT
-PE can block oxygen exchange, cause sudden incapacitation, and is associated with significant morbidity and mortality

Question 29

When is a driver who has pulmonary embolism eligible for certification?

Answer 29

asymptomatic
-at least 3 months post PE with no recurrent PE
-on appropriate long term treatment
-no disqualifying cardiovascular dz

Question 30

What is the required waiting period after a driver has had a PE?

Answer 30

3 months

Question 31

When would you not certify a driver with pulmonary embolism?

Answer 31

symptomatic
-has disqualifying cardiovascular dz

Question 32

How often must a driver with PE be recertified

Answer 32

-Annual recertification and annual medical exam

-if driver is being treated with anticoagulants, must meet INR monthly monitoring guidelines