Misc
When to stop Factor Xa inhibitors or Direct thrombins?
Depends on patients kidney function and bleeding risk
Visual Requirements?
Acuity..Fields..Colors?
At least 20/40 in each eye with or without corrective lenses
Field of vision of at least 70 degrees
Red, Green, Amber
Important things to note while obtaining pre op history
Medical conditions are well managed
Personal/fam history of adverse reactions to anesthesia, blood clots, or bleeding problems
A 5-10% weight loss can help with what??
Which hormone increases adiposity
lowering blood pressure, lowering cholesterol, lowering glucose, relieving osteoarthritis complications
Ghrelin
Metabolic syndrome numbers:
Fasting glucose?
BP?
Trigylcerides?
HDL?
Waist circumference?
Glucose >100
BP >130/85
Trig >150
HDL <40
Waist >40in men >35 in women
Patient on Norvasc--okay to take or stop before surgery?
OK to take day of surgery
Hearing Requirements
Forced whisper no less than 5 feet with/without hearing aids
Audiometry--greater than 40 dB
If driver wears hearing aids--make sure to have extra batteries with him
Important screening question with sports physical
Family hx of cardiac events?
Sudden death before age 50 attributable to heart
disability of heart disease in close relative <50
Cardiomyopathy, QT sydrome, Marfan, arrhythmias
Medications that contribute to weight gain
tricyclics, MAO inhibitors, some SSRIs, atypical antipsychotics, lithium, some anticonvulsants
insulin, sulfonylureas, thiazolidinediones
Antivirals, Tamoxifen, Steroids, Some oral contraceptives
What conditions would you see acanthosis nigricans?
Metabolic syndrome
Also seen in PCOS
Sudden cardiac death in young atheletes is mostly like due to??
cardiomyopathy
BP Requirements
hypertension should be recertified more frequently. If the driver’s blood pressure is less than or equal to 140/90 they may be certified for one year.
blood pressure greater than 140/90 but less than 160/100 may be granted a one time certificate for 3 months
greater than or equal to 180/110 should be disqualified until the blood pressure is less than or equal to 140/90
Murmurs and HTN
When to refer
Murmur that is softer while squatting and louder while standing or Valsalva--r/o cardiomyopathy or MVP
HTN--Stage 2
complications of OSA
pulmonary HTN
systemic HTN
Cardiac arrhythmias
Overall increased morbidity and mortality
What is the maximum amount of time allowed for CDL cert?
2 years
medicare wellness visit is covered by??
Medicare Part B
Respiratory Requirements
OSA compliance?
Lung disease--The Driver must have FEV1>65%, FEV1/FVC>65%, and FVC>60.
over the age of 35 that smoke cigarettes provide the examiner recent pulmonary function testing
must provide to the examiner their CPAP Compliance record in order to be certified. CPAP machine at least 4 hours a night over a 30 day period for at least 70% of the time
What is concerning if child has mono with contact sports?
How long is it recommended to sit out?
Splenic rupture
Avoid all exertion for 3 weeks--case by case basis but at least 4 weeks post symptom onset. Contact sport may be longer
Overweight and Obesity puts at risk for?
hyperinsulinemia and metabolic syndrome
CV complications--heart disease, HTN
DM
Cancer
Patient taking warfarin before surgery..when should she stop?
5 days prior
MAXIMUM cert for patient with DM and HTN
one year--if controlled
Disqualifying Conditions
Cardiomyopathy, AICD, Meniere's disease
hearing loss >40dB, Dialysis, monocular vision
peripheral neuropathy, epilepsy, dementia
pulmonary HTN, methadone, benzos, marijuana
Untreated Sleep Apnea, Active psychoses, Chantix?
When to return after ringworm?
When to return after MRSA, cellulitis, or impetigo?
Minimum of 72 hrs on topical fungal; covered lesions
no new lesions for 48 hrs--minimum of 72 hrs on antibiotic therapy
Nutritional deficiencies after bariatric surgery
B12, iron, B complex, and Ca
**lifelong supplementation
Patient taking herbal medications..when to stop prior to surgry?
At least 7 days