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Head surgery 3 years ago from bullet, lost consciousness for 36 hours after incident. No seizures post injury, no current meds, no other health issues. Qualify? โโNo, pt is at high risk of post- traumatic brain seizures Persons who have sustained penetrating injuries to the brain or severe TBI with loss of consciousness >24hrs = permanently disqualified due to high risk of neuro deficits and seizures even many years after incident Stage 1 HTN (According to FMCSA) โโ 140 - 159/90- 99 Stage 2 HTN (according to FMCSA) โโ 160 - 179/100- 109 Stage 3 HTN (according to FMCSA) โโ>180/ 2 cases where you can do a one time 3 month certificate for HTN โโ1. Stage 2 BP (160- 180/100-110) with no hx of HTN or use of antihypertensives
- Certified with Stage 1 HTN (140-159/90-99) and has not acheived BP <140/90 at recertification Hx of stage 3 HTN who has an acceptable BP at exam (<140/90), tolerates tx with no side effects, certification period โโ 6 months Pt has missing 4th R finger, provides report confirming strong right hand grasp. Does this person require SPE and why? โโNo as long as medical report confirming no interference with hand grasp power or prehension, a SPE certificate is not required for impairment/loss of finger.
Thoracic aortic aneurysm 2.9cm. How would you handle this case and what is medical certification period? โโQuery and evaluate other associated cardiovascular diseases; annual cert TAA <3.5cm may be certificied annually after thorough eval Qualifying thoracic aortic aneurysm size โโ<3.5cm Pt had surgery for 5.0cm AAA 1 year ago, cardio clearance, asymptomatic. Qualified and if so how long? โโYes, 1 year Must be >3months from surgery with clearance and asymptomatic Which of the following neuro healthy history is IMMEDIATELY disqualifying? a. transient global amnesia b. transient sleep disorders causing excessive daytime somnolence c. number of unprovoked seizures within period of 6 years d. all the above โโC. hx of epilepsy is disqualifying Prominent risk factors for OSA โโBMI > Small jaw Large neck >17in males, >15.5in females Small area Family hx Pt with DM previously treated with oral meds and now required insulin must establish a control of hypoglycemia or hyperglycemia for a period of: โโ 1 month
d. none of the above โโc. drug and ETOH testing required for all fatal crashes and when the driver is cited for a moving traffic violation Medical examiners are required to keep driver medical records for how long? โโ 3 years CABG - which of the following should happen before the driver can be certified? a. specialist's approval b. sternum healed c. 2 year wait period d. all of the above โโb. sternum healed Personality disorders may interfere with driving ability by compromising which of the following abilities? a. speech b. visual-spatial function c. mobility d. none of the above โโb. visual spatial function also at risk for motor response latency Major mood disorder should be evaluated by mental health professional how often? โโat least every 2 years Which vision disorder is an ophthalmologist eval report NOT required ancillary info? โโMonocular vision
Because this is a disqualifying condition A driver with DM who does NOT use insulin is eligible for certification unless โโthe driver also has a comorbidity, a disqualifying complication or fails to meet one or more of the standards for qualification driver who uses narcotic or habit forming drugs, examiner should determine if the driver has which of the following? a. therapeutic or habitual need b. if driver has a goal to alter mood, affect, or state of consciousness c. hx of drug rehab d. all the above โโd. all the above DM with no other disqualifying conditions may be certified for how long? โโ 1 year max Stroke with brainstem vascular lesions. Can the driver be certified? โโYes after 1 year waiting period brainstem vascular lesions not at an increased risk for seizures A driver with compromised mobility and difficult climbing stairs and ladders. How too handle this case? โโA driver's inability to perform arduous physical tasks should be strongly considered Prosthetic valve may not be certified if EF less than what? โโ40%
b. hx of epilepsy c. current dx of alcoholism d. all the above โโall the above T2DM takes byetta can be certified under which of the following guidelines? a. 1 year waiting period b. 6 month waiting period c. can be certified without exemptions d. none of the above โโByetta = incretin mimetics can be certified without exemptions Driver being treated with arthritis. How should case be handled? a. disqualified b. refer to specialist c. certify without exemptions d. needs SPE โโrefer to specialist If driver has had heart transplant, which of the following is NOT a consideration for examiner to recommend certification? a. driver has no signs of transplant rejection b. donor <35 yo c. has not required any f/u meds d. driver has 3 or fewer symptoms โโa. driver has no signs of transplant rejection
heart transplant waiting period โโ 1 year heart transplant max certification period โโ 6 months 37yo male answered yest when asked if he has high bp. For this answer you need to discuss with or ask the driver for additional info EXCEPT for: a. treating physician contact info b. prescribed meds used in relation to his HTN c. OTC meds d. None of the above โโnone of the above need to know all of these hx of alcoholism may be certified under which of the following conditions? a. no residual disqualifying physical impairment b. successfully completed counseling and/or tx c. no current disqualifying alcohol-related conditions d. all the above โโall the above ADHD can be certified under which of the following circumstances a. tolerates tx without side effects signs of organ rejection, has clearance from cardio, meets all other qualification requirements May recommend certification in heart transplant if asymptomatic, tolerates meds, shows no
chronic thrombotic venous disease max certification period โโ2 years if stable and asymptomatic Has pacemaker for AV block, waiting period โโ 1 month pacemaker for sinus node dysfunction, waiting period โโ 1 month pacemaker for neurocardiogenic syncope waiting period โโ 3 months pacemaker for hypersensitive carotid sinus with syncope โโ 3 months IF a pt has a pacemaker what do they need to provide โโdocumentation of pacemaker function checks at examination Supraventricular Arrhythmias waiting period โโ 1 month
- Afib with anticoag
- Post thoracic surgery with anticoag
- Aflutter
- AV nodal reentrant tachy
- AV nodal reentrant tachy & Wolf parksinon
- Atrial tachy
- Junctional tachy ventricular arrhythmias waiting period โโ 1 month
- coronary heart disease
- R vent outflow VTach
- Idiopathic L vent outflow vtach Arrhythmias that are disqualifying โโSustained vtach NSVT with LVEF <40% Hypertrophic cardiomyopathy Long QT interval syndrome Brugada syndrome ETT Met requirement โโ>6 METs LVEF passing โโ>40% Acute MI waiting period โโ2 months Needs:
- EF >40%
- No ischemic changes on ECG
- Tolerating meds
- asymptomatic
- passing ETTT Stable Angina waiting period โโ 3 months with no rest angina or change in angina pattern multiple CHD risk factors max certification โโ 1 year
post percutaneous balloon mitral valvotomy waiting period โโ 1 month post surgical commissurotomy waiting period โโ 3 months post prosthetic valve replacement waiting period โโ 3 months post ballon valvulopalsty waiting period โโ 1 month post surgical valvotomy waiting period โโ 3 months get PFTs if: โโ- hx of specific lung disease
- SOB, chest tightness, cough, wheezing
- smoker 35yo and older if pulse ox <92% driver must have โโABG analysis PFT passing FEV1 value โโ>65% ABG PaO2 and PACO2 failing โโPaO <65mmHg at below 5000 ft <60mmHg at above 5000 ft PaCO
45mmHg at any altitude
beginning cpap waiting period โโ 1 month if 2 spontaneous pneumothorax on same side what does driver need โโsurgical intervention to prevent recurrence waiting period: mild insult without early seizures, stroke without risk for seizures, intracerebral or subarachnoid hemorrhage without risk for seizures โโ 1 year seizure due to brain insult max cert โโ 1 year Waiting period: moderate insult without early seizures, mild insult with early seizures โโ 2 years Waiting period: moderate insult with early seizures, stroke with risk for seizures, intracerebral or subarachnoid hemorrhage with risk for seizures โโ 5 years area of brain with lesions associated with risk of seizures โโcerebral cortical or subcortical deficits NOT cerebellum or brainstem lesions Seizure due to metabolic illness waiting period โโnone if underlying cause was found and corrected and stable Seizure due to metabolic illness max cert โโ 2 years initial/single unprovoked seizure waiting period โโ 5 years
centronuclear myopathy congential muscular dystrophy rod (nemaline) myopathy can you certify inflammatory myopathies โโNO dermatomyositis inclusion body myositis polymyosiitis Benign supratentorial tumors, spinal tumors post surgery waiting period โโ 2 years all other benign tumors 1 year type of tumors that can't be certified โโprimary or metastatic malignant tumors of nervous system benign nervous sytem tumors tia or stroke waiting period โโ1 year if no risk of seizure 5 years if risk of seizures (cortical or subcortical deficits) severe head injury definition โโpenetrates dura LOC >24 hours high risk of seizures cannot ceritfy (includes surgeries that penetrate dura)
moderate head injury definition โโdoes NOT penetrate dura LOC >30 mins - <24 hrs mild head injury definition โโno dural penetration LOC <30 mins moderate tbi with early seizures waiting period โโ5 years mild tbi with early seizures, moderate tbi with no seizures wiaitng period โโ 2 years driver who has been denied certification because of metabolic muscle disease may have that decision reconsidered on what basis? a. recommendation by a specialist to take a simulated driving test b. it cannot be reconsidered c. successful treatment d. none of the above โโa. recommendation by a specialist to take a simulated driving test eval by neurologist or physiatrist who understands the functions and demands, specialist may recommend stimulated riving skills test or equivalent functional test or annual recent that repeats the specialist eval and riving test when indicated hx of migraines whose condition does not interfere with health and safey, max cert โโ 2 years ECT waiting period โโ 6 months symptom free following last treatment driver with mild mitral regurg and afib. can driver be certified?
