NRCME DOT welcome, vision, hearing, cardio Questions and Complete Solutions Graded A+

  Medical standards/regulations are - Answer: mandatory Medical guidelines are - Answer: advisory If choosing not to follow medical guidelines, you should note the rationale for not following the guidelines in the... - Answer: Medical Examination Report 4 required tests in the examination - Answer: vision, hearing, blood pressure/pulse, and dipstick urinalysis. Dipstick urinalysis includes... - Answer: specific gravity, blood, protein, and glucose. T/F Recurrence of a disqualifying condition resets the waiting period. - Answer: True Maximum certification interval - Answer: 2 years Minimum retention period of records - Answer: 3 years Vision requirement: distance - Answer: 20/40 in each eye and both eyes together for distance with or without correction, Vision requirement: field of vision - Answer: of at least 70 degrees in the horizontal meridian of each eye Vision requirement: color - Answer: green, red, amber Definition of monocular vision - Answer: as vision in at least one eye that is worse than 20/40 for distance with or without correction Unacceptable vision correction - Answer: contact lenses that correct for one eye for distance and one eye for near vision OR telescoping lens Vision exemption granted for ? years. Pt should be examined ? years though and by who - Answer: 2 years, 1 year by medical examiner and opth or optometry Contact for vision exempt - Answer: Tests for hearing - Answer: Whisper test or audiometric testing equipment Hearing requirement: forced whisper - Answer: able to hear from 5 feet in at least 1 ear Hearing requirement: audiometric testing equipment - Answer: hearing loss of no more than 40 decibels averaged across 500 Hz, 1000 Hz, and 2000 Hz in at least 1 ear Audiometric hearing equipment calibrated to whose standards - Answer: American National Standards Institute (ANSI) standard. If International Organization for Standardization (ISO) results are used, these results must be converted to ANSI results. If pt has hearing aid, can you use audiometric testing equipment? - Answer: No, only audiologist or otolaryngologist If a driver requires use of a hearing aid to pass hearing requirements, the requirement to wear a hearing aid must be noted on ?? what - Answer: both the Medical Examination Report and the Medical Examiner's Certificate. symptom free waiting period for acute and chronic vestibulopathy - Answer: 2 months symptom free waiting period for benign positional vertigo. - Answer: 2 months 4 guidance recommendations for hearing does the FMCSA recommend not to certify drivers? - Answer: diagnosis of uncontrolled vertigo, Meniere's disease, nonfunctioning labyrinth, and nonfunctioning fistula. MI waiting period - Answer: 2 months MI max certification interval - Answer: 1 year MI requirements for cert - Answer: EF40 no recurrent angina No ischemic changes on EKG Tolerates meds ETT satisfactory and q 2years Cardiology clearance Do you have to get cardiology clearance after MI? If so, how often - Answer: Yes, once ETT must be satisfactory and performed how often with diagnosis of: MI - Answer: every 2 years ETT must be satisfactory and performed how often with diagnosis of: CABG - Answer: ETT yearly beginning 5 years post CABG ETT must be satisfactory and performed how often with diagnosis of: PCI - Answer: ETT 3-6 mo post PCI then q2 years CABG waiting period - Answer: 3 months CABG max cert interval - Answer: 1 year Do you have to get cardiology clearance after CABG? If so, how often - Answer: yes, once PCI waiting period - Answer: 1 week PCI max cert interval - Answer: 1 year Do you have to get cardiology clearance after PCI? If so, how often - Answer: Yes, once pacemaker implantation: supraventricular arrhythmias or sinus node dysfxn waiting period - Answer: 1 month, documented correct paper fxn pacemaker implantation: supraventricular arrhythmias max cert interval - Answer: 1 year pacemaker implantation: ventricular arrhythmias or neurocardiogenic syndrome waiting period - Answer: 3 months pacemaker implantation: ventricular arrhythmias max cert interval - Answer: 1 year How often must pacemaker be checked and proof documented if in place? - Answer: annually Heart transplant waiting period - Answer: 1 year asymptomatic Heart transplant max cert interval - Answer: 6 months Do you have to get cardiovascular clearance after heart transplant? If so, how often - Answer: yes, once Syncope (cardiovascular) waiting period - Answer: not specified - etiology has to be confirmed, tx adequate/tolerated, stable, clearance from cardiology Do you have to get clearance from cardiology for cardiovascular syncope? If so, how often - Answer: yes, once Syncope (cardiovascular) max cert interval - Answer: 1 year Angina waiting period - Answer: 3 months Angina max cert - Answer: 1 year Do you have to get clearance from cardiology for angina? If so, how often - Answer: yes, yearly ETT must be satisfactory and performed how often with diagnosis of: angina - Answer: q 2 years Angina requirements for certification - Answer: Stable angina, no rest angina or change in pattern Tolerate medications, otherwise asxatic Resting SBP 95 and no decline 20mmHG upon standing Satisfactory ETT Cardiology specialist visit yearly ETT q 2 years CHF waiting period - Answer: not specified CHF max cert interval - Answer: 1 year CHF requirements for cert - Answer: Pt must be asxatic (if sxatic, disqualify) No ventricular arrhythmias EF40 Cardiology clearance Cardiology eval annually - with Holter monitor and echo Implantable defib requirements - Answer: disqualifying hypertrophic cardiomyopathy or restrictive cardiomyopathy requirements - Answer: disqualifying 4 coronary heart disease (CHD) equivalent conditions - Answer: DM, PVD, age 45 with multiple cardiac risk factors, framingham risk predicting 20% event risk over 10 years With the 4 CHD equivalent conditions, what must be met in order to certify - Answer: Asxatic No ischemic changes on EKG No functional incapacitation from conditions Consider ETT Minimum ETT requirements (6 total) - Answer: 1. exercise to at least 6 METS (metabolic equivalents) (through Bruce Stage II or equivalent ), 2. attain a heart rate 85% of predicted maximum (unless on beta blockers), 3. attain a rise in SBP 20 mmHg without angina, 4. have no significant ST segment depression or elevation 5. have no marked T wave abnormality 6. have no ventricular dysrhythmia. A-fib/flutter requirements - Answer: asymptomatic If cause of or risk for stroke, must have at least 1 month of adequate anticoagulation, anticoagulation monitored by INR if warfarin (Coumadin) used rate/rhythm control adequate, cardiologist assessment recommended. If arrhythmia treated, must be at least 1 month after procedure, cleared by electrophysiologist. Abd aneurysm 4.0 certify if: (3) - Answer: 4.0 cm and the driver is asymptomatic. At least three months after surgical repair and meets post-surgical repair guidelines. Cleared by cardiovascular specialist. Aneurysm 4 cm but 5 cm - Certify if: (2) - Answer: Driver is asymptomatic and cleared by a cardiovascular specialist who understands CMV driving demands. At least three months after surgical repair and meets post-surgical repair guidelines. If surgical repair of abd or thoracic aneurysm occurs, what is the waiting period? Clearance is needed by whom? - Answer: 3 months Cardiovascular specialist Maximum certification for abd or thoracic aneurysm - Answer: 1 year Disqualifications for abd aneurysm? (4) - Answer: 1. symptomatic 2. aneurysm is 5.0 cm 3. if there has been more than 0.5 cm increase in size over 6 months 4. if surgery has been recommended but not performed Thoracic - Certify if: (3) - Answer: 1. 3.5cm 2. at least 3 mo after surgical repair 3. cleared by cardiovasc Aneurysms in visceral and peripheral arteries and venous vessels - Certify if: (2) - Answer: At least three months after surgical repair. Cleared by cardiovascular specialist. Anticoagulant therapy for cardiovascular condition - certify if Do not certify if... - Answer: stabilized on medication at least 1 month, INR results available and therapeutic, monthly INR monitoring required. not... if the driver has cerebrovasc disorder due to risk of intracranial bleeding Minimum waiting period for anticoag use - Answer: 1 mo stabilized Max cert interval for anticoag use - Answer: 1 year Aortic stenosis: if mild or moderate and asxatic, max cert interval - Answer: certify, max 1 year Aortic stenosis mild: echo requirements, how often? - Answer: q 5 years Aortic stenosis moderate: echo requirements - Answer: q 1-2 years Aortic stenosis: severe - Answer: surgical tx and wait 3 mo post surgery - clearance from cardio Echo 2D required at discharge Max cert for DVT - Answer: 1 year Max cert for superficial phlebitis or varicose veins - Answer: 2 years PVD: do not certify if... - Answer: sxatic, pain at rest Pt with PVD undergoes surgical revasc... waiting period? - Answer: 3 mo