The Aerospace Medical Association is dedicated to the science of Aerospace Medicine. The following questions and answers offer those interested in Aerospace Medicine activities the opportunity to test and expand your Aerospace Medicine knowledge.
| Question: |
An aspiring student pilot arouses your clinical interest by mentioning the many different jobs he has held, mainly unskilled or semiskilled. He left each because of personality conflicts, or "just to move along". As his history develops, you ascertain that his high school career was marked by truancy, fist-fights, and suspensions. He has had several brushes with the law, including charges of passing bad checks. His sexual career has been promiscuous. At 22, he is separated from his second wife. For all this, however, you find him a charming and disarmingly honest young man with a ready smile and evident intelligence. The most likely diagnosis is:
a. passive-aggressive personality disorder.
b. temporal lobe epilepsy.
c. antisocial personality disorder.
d. adjustment reaction of late adolescence.
e. explosive personality disorder.
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| Answer: |
c. Antisocial personality disorder is marked by basically unsocialized behavior which brings the individual (usually male) into repeated conflict with society. Such persons have loyalty to no group or social values. Their background frequently includes a chaotic childhood situation, and their symptoms usually begin by mid-adolescence. School problems, running away, legal entanglements, poor work history, marital difficulties, frequent fights, sexual promiscuity (heterosexual and/or homosexual), vagrancy or wanderlust, and a blithe disregard for truth mark this disorder. At best these people are charming rogues; at worst they are conscienceless criminals.
People with passive-aggressive traits are obstructionist, procrastinating, stubborn, and intentionally inefficient. They express hostility covertly rather than openly. The behavioral aberrations of temporal lobe epilepsy are episodic and generally disorganized rather than purposeful; the patient is usually unaware of them.
Adjustment reactions, whether adolescent or adult, are temporary disturbances that follow a clear-cut and unusual life stress. The explosive personality is characterized by gross outbursts of rage or aggressiveness, out of character for the patient and regretted by him.
REFERENCES:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 2nd Ed. Washington DC: American Psychiatric Assoc, 1968:42,43,49.
Woodruff RA, et al. Psychiatric Diagnosis. New York: Oxford University Press, 1974:143-155.
Jones DR, Katchen MS, Patterson JC, Rea M. Neuropsychiatry in Aerospace Medicine. In: DeHart RL, ed. Fundamentals of Aerospace Medicine, 2nd ed. Baltimore: Williams & Wilkins, 1996:593-642. |
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| Question: |
A cohort study of occupational exposures to 2,3,7,8-tetrachlorodibenzo-p-dioxin (dioxin) and cancer found a crude relative risk of 1.00 when comparing the index and control groups. A stratified analysis within each of two levels of age (young, old) found a relative risk of 3.0 in the young stratum and 3.0 in the old stratum. This data provides an example of:
a. confounding and interaction
b. no confounding and interaction
c. confounding and no interaction
d. no confounding and no interaction
e. strong interaction and irrelevant confounding
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| Answer: |
c. Confounding is present when the adjusted relative risk differs from the crude relative risk. An interaction is present when the relative risk changes across levels of a stratified analysis. Hence, the example represents confounding, because the adjusted relative risks (3.0 in each stratum) differ from the crude relative risk (1.0) and no interaction because the stratum-specific relative risks are not different.
REFERENCES:
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research. Principals and Quantitative Methods. New York: Van Nostrand; 1982. |
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| Question: |
Which of the following statements is TRUE regarding coronary artery disease in women?
a. The absolute number of deaths from cardiovascular disease in the US is higher in women than in men.
b. High density lipoprotein (HDL) levels generally remain lower in women than in men throughout life.
c. The use of current oral contraceptives is not associated with increased risk of cardiovascular disease in non-smoking women over 40 years of age.
d. The use of oral estrogen therapy in post-menopausal women has been shown to significantly decrease the risk of myocardial infarction.
e. All of the above
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| Answer: |
a. Cardiovascular disease is the leading cause of death of women in the United States. Though women tend to develop disease later in life than men, the generally longer lifespans of women result in more total disease. In addition to sharing the risk factors for men (hyperlipidemia, hypertension, smoking, family history, and obesity), women have been at risk from oral contraceptive use, especially for smokers over the age of 40. The role of oral contraceptive use as an independent risk factor appears to have been reduced by reformulation of oral contraceptives in recent decades. Estrogen replacement in women, previously thought to significantly reduce their risk for myocardial infarction or death, is no longer felt to be protective.
REFERENCES:
Kuhn FE, Rackley CE. Coronary Artery Disease in Women. Arch Intern Med 1993 Dec 13;153:2626-2635. |
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| Question: |
An individual who has had a previous frostbite has _________ susceptibility to subsequent cold injury.
a. increased
b. decreased
c. no change in
d. none of the above
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| Answer: |
a. Recurrent first degree frostbite decreases peripheral blood flow, increases cold sensitivity, and increases the risk to subsequent frostbite.
REFERENCES:
Pandolf KB, Sawka MN, Gonzalez RR, eds. Human Performance Physiology and Environmental Medicine at Terrestrial Extremes. Indianapolis: Benchmark Press, 1988.
Sumner DS, Criblez TL, Doolittle WH. Host Factors in Human Frostbite. Military Med 1974;141:454-461.
Wagstaff MA, Pethyridge RJ. Cold Injuries Norwegian Winter Deployment-Great Britain: Institute of Naval Medicine, Alverstoke Hants, 1986, Report #20/86. |
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| Question: |
Which foodborne disease agent grows vigorously in a 10% salt solution, a concentration which inhibits the growth of most bacteria?
a. Clostridium perfringens
b. Bacillus cereus
c. Staphylococcus aureus
d. Salmonella species
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| Answer: |
c. Staphylococcus aureus tolerates sodium chloride to the extreme that it has been reported to grow in solutions containing salt in concentrations as high as 22%. This is significant because of meat items incriminated with Staphylococcal intoxication, ham has been most often reported. The salt concentration of the ham tends to inhibit other organisms which normally compete with Staphylococci and keep them under control, while the salt allows the Staphylococci to grow producing a heat stable enterotoxin.
REFERENCES:
Bryan FL. What the Sanitarian Should Know About Staphylococci and Salmonellae in Non-Dairy Products, I. Staphylococci. J Milk Food Tech 1968;31:110-116.
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| Question: |
The largest payer for health care in the U.S. is:
a. Traditional Insurance Plans
b. Health Maintenance Organizations (HMOs)
c. Government
d. Consumers
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| Answer: |
c. Federal and State government payments account for 39% of U.S. expenditures for health services and supplies .
REFERENCES:
Cowan C., Hartman M.; “Financing Health Care: Businesses, Households, and
Governments, 1987-2003”, http://www.cms.hhs.gov/apps/review/web_exclusives/cowan.pdf |
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| Question: |
A statistically significant association has been shown between administration of A/New Jersey influenza vaccine in 1976 and the subsequent development of which of the following?
a. Severe A/New Jersey influenza
b. Post-vaccinal encephalitis
c. Guillain-Barré syndrome
d. Gilbert’s syndrome
e. Aseptic meningitis
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| Answer: |
c. "In June, 1978, CDC convened an expert group to review and comment on these data (the GBS surveillance data) relating to GBS cases and vaccine lots. The group concluded that there was no substantive evidence for any single lot or group of lots having any unusual or significant propensity to produce GBS beyond that which would be expected by normal biological variation. The statistically significant association between GBS and the A/New Jersey influenza vaccine, however, was reaffirmed."
REFERENCES:
MMWR Weekly. 1979 Jun 19;28(2):22-23. |
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| Question: |
The most successful prevention strategies are generally those that are:
a. active
b. passive
c. an active procedure supported by a passive procedure
d. a passive procedure supported by an active procedure
e. none of the above
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| Answer: |
b. The most successful prevention strategies are generally those that work automatically (i.e., passive strategies). In contrast, active strategies require that people change their behavior and remember to repeat the new behavior every time they are exposed to risk. For example, helmets can prevent serious bicycling injures, but the rider first must be persuaded that wearing a helmet is valuable and then must remember to wear the helmet on every ride. Making roadways and vehicles safer has done more to decrease injuries from motor vehicle crashes than exhortations to drive carefully. Safety caps on medication bottles have been effective in reducing deaths from poisoning among children; whereas warning stickers and reminders to parents to lock up medications and household poisons are relatively ineffective. In practice, many injury-prevention programs consist of both passive and active strategies, but an emphasis on the passive component is more likely to result in a sustained decrease in injuries.
REFERENCES:
Rivera FP, Grossman DC, Cummings P. Injury Prevention: First of Two Parts. N Engl J Med 1997 Aug;337(8):543-548. |
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| Question: |
Developmental difficulties are much more frequent causes of preventable morbidity in children than major birth defects. Maternal consumption of which of the following factors is the leading cause of preventable mental retardation in children?
a. Prescribed medications
b. Over-the-counter medications
c. Marijuana
d. Cigarettes
e. Alcohol
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| Answer: |
e. Fetal alcohol syndrome is the most commonly identified preventable cause of mental retardation in children with 6 cases per 10,000 deliveries reported in 1993. Fetal alcohol syndrome will affect approximately 1/750 children. Marijuana has not been associated with any pregnancy-related effects. Cigarette smoking has been associated with a mean reduction of birth weight of 200 grams, but not mental retardation. Medications only account for about 1% of all known birth defects.
REFERENCES:
Drugs and Medications. In: Cunningham. et al, eds. Williams Obstetrics, 20th ed. Stamford: Appleton and Lange, 1997.
American College of Obstetrics and Gynecology. Teratology. ACOG Technical Bulletin No. 236, 1997 Apr.
Bradley L. The Adult Female. In: Matzen, Lang, ed. Clinical Preventive Medicine. Mosby, 1993. |
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| Question: |
Human exposure to benzene often involves concomitant exposure to other solvents and animal exposures have not supported the view that benzene is a leukemogen. Clinical and epidemiologic data do however suggest a leukemogenic effect in humans, the leukemia most commonly being:
a. acute and myeloblastic.
b. chronic and lymphocytic.
c. acute and lymphocytic.
d. chronic and myelomonocytic.
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| Answer: |
a. There have been some reports of an association between benzene and chronic or lymphocytic leukemias but this association has not been widely accepted. If it does occur, it does so only rarely and has not been reported in recent years.
REFERENCES:
Proctor NH, Hughes JP. Chemical Hazards of the Workplace. Philadelphia: Lippincott, 1978:118-120. |
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| Question: |
Of the 304 F-16 class A mishaps in the US Air Force from 1975 to 2003 the three PRIMARY causes were:
a. pilot induced control loss, fuel system, birdstrikes
b. flight controls, electrical, G-induced loss of consciousness
c. engine failure, collision with ground, and midair collision
d. spatial disorientation, loss of situational awareness, and pilot induced control loss
e. weather, fatigue, and pilot-induced flameout
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| Answer: |
c. Engine failure, collision with ground, and midair collision account for the majority of the primary causes of Class A mishaps. The other answers were also causes of Class As, but they do not total more than 25% of the total.
REFERENCES:
Knapp CJ, Johnson R. F-16 Class A Mishaps in the US Air Force. Aviat Space Environ Med 1996 Aug;67(8):777-783 (Table III).
Newman Gregory R, ,”F-16” Flying Safety, Jan-Feb, 2004 |
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| Question: |
Symptoms of acute mountain sickness at 5000 m include malaise, vomiting and intractable headache. The symptoms have been found to be closely related to:
a. inner ear hydrops, nausea and vertigo.
b. renal oliguria, excess sodium retention and acidosis.
c. hyperventilation, excess sodium retention and acidosis.
d. psychosomatic reactions to the mountain environment.
e. cerebral edema, pulmonary gas abnormalities and pulmonary edema.
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| Answer: |
e. The severity of acute mountain sickness (AMS) was investigated in healthy volunteers, airlifted to high altitude (5,360 m). Blood gases were measured at 2,990m and 5,360m. Symptoms of AMS were found in all subjects, but ranged from malaise to vomiting with intractable headache. The clinical severity of AMS was directly related to the arterial PCO2 and inversely to pH, but unrelated to the PO2 on arrival at high altitude. However, PO2 fell and was lowest 48 hours after arrival at high altitude in those subjects with the most severe AMS. These were the only subjects to show an increase in the alveolar-arterial PO2, difference and in the venous admixture ratio during the first 48 h. These abnormalities in gas exchange, which developed in the subjects with the most marked cerebral symptoms, suggest that the manifestations of cerebral and pulmonary dysfunction at altitude develop simultaneously, a finding that suggests coexisting cerebral and pulmonary edema.
REFERENCES:
Sutton et al, Aviat Space Environ Med 1976 Oct:1032. |
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| Question: |
The following statements concerning the cabin environment in pressurized commercial aircraft are true EXCEPT:
a. At a barometric pressure of 8,000 feet within the cabin, normal adult hemoglobin is approximately 90% saturated.
b. Cabin humidity in commercial aircraft usually ranges from 10-20%.
c. Ozone levels within a pressurized aircraft are approximately equal to outside ambient concentration.
d. The risk of ionizing radiation exposure generally increases with increasing altitude and latitude.
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| Answer: |
c.
REFERENCES:
Medical Guidelines for Air Travel. Aviat Space Environ Med 1996 Oct;67(10, Suppl.): Section 11.
Harding RM, Mills FJ. Aviation Medicine. London: GMJ Publishing Group, 1993.
DeHart RL. Fundamentals of Aerospace Medicine, 2nd ed. 1996, Baltimore: Williams & Wilkins. |
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| Question: |
Evidence that burning interior furnishings add to the hazards of occupants escaping from the postcrash fire in large aircraft is probably best reflected by which of the following?
a. Witnesses who attest to the melting and burning of interior materials.
b. The postcrash finding of frothy ashes on oxidized metallic parts.
c. The finding of hydrogen cyanide in the blood and tissues of accident victims.
d. Blackening of the trachea of accident victims.
e. The observance of "flash over" in the burning cabin as the fire progressed.
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| Answer: |
c. Aircraft fuel does not contain appreciable amounts of nitrogen; therefore, the most significant finding of hydrogen cyanide in the accident victims indicates that hydrogen cyanide must have come from nitrogen-containing combustible materials that are part of the cabin structure or in the cabin.
REFERENCES:
Kirkham WR, Lacefield DJ, Crane CR. Toxicological and Pathological Findings in Aircraft Accident Victims that Indicate Incapacitation from Burning Interior Materials. Paper presented at Annual Meeting of Aerospace Medical Assoc Washington, DC, 1979 May 14-17. |
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| Question: |
At high altitude, the mechanical problem of compression of air because of its low density limits the utilization of the pressurized cabin to:
a. 16 km (10 miles).
b. 26 km (16 miles).
c. 39 km (24 miles).
d. 45 km (28 miles).
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| Answer: |
d. A sanitary airport is an airport, designated as sanitary by the local health administration of a State. The health administration shall designate a number of sanitary airports in its territory, provided they meet the provisions of article 14 and the conditions of paragraph 2 of article 18 of the IHR. These provisions and conditions are listed in answer option (d).
Answer (a). This option covers only two of the many conditions and provisions required.
Answer (b). WHO is a specialized agency within the United Nations' system; dedicated to the promotion of global health, it establishes inter alia international regulations such as the IHR, but each Member State is responsible for the implementation of these regulations. Consequently, it is for the local health administration, not for the WHO, to designate an airport as sanitary.
Answer (c). There are two provisions in the IHR allowing a State to specify certain airports for isolation of passengers: (1) for aircraft carrying persons taking part in periodic mass congregations, and (2) in areas where the vector of yellow fever is present, for aircraft coming from an infected area. These two provisions do not form part of the definition of a sanitary airport.
Answer (e). All airports shall be kept free from Aedes aegypti and the mosquito-vectors of malaria and other diseases of epidemiological significance in international traffic. For this purpose active anti-mosquito measures shall be maintained within a protective area extending for a distance of at least 400 metres around the perimeter. This requirement is not one of the specific conditions or provisions for sanitary airports.
REFERENCES:
International Health Regulations, 3rd annotated ed. Geneva: WHO, 1983.
ICPS Environmental Health Criteria 96 - d-Phenothrin. Geneva: WHO, 1990.
Annex 9 to the Convention on International Civil Aviation, ICAO Doc. AN 9, 9th ed. Montreal: ICAO, 1990. |
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| Question: |
The usual effective performance time (a.k.a. time of useful consciousness) when breathing air at altitudes of 25,000 ft (7620 m) and 35,000 ft (10,670 m) respectively are:
a. 25 min; 90-120 sec
b. 15 min; 60-90 sec
c. 3-5 min; 30-60 sec
d. 2-3 min; 15-30 sec
e. 1-2 min; 10-15 sec
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| Answer: |
c. EPT is 3-5 min at 25,000 ft and 30-60 sec at 35,000 ft. Answers (a), (b), (d), and (e) are incorrect. EPT is 20-30 min at 18,000 ft, 10 min at 22,000 ft, 2-3 min at 28,000 ft, and 1-2 min at 30,000 ft.
REFERENCES:
Sheffield PJ, Heimbach RD. Respiratory Physiology. In: DeHart RL, ed. Fundamentals of Aerospace Medicine. Philadelphia: Lea & Febiger, 1985:97. |
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| Question: |
One of the major conclusions of the 5-year study of air traffic controller in the northeastern US was that:
a. working as an air traffic controller leads to high rates of coronary disease.
b. the work of air traffic control is unusually stressful.
c. controllers who were dissatisfied with their work had increased risk of negative health change.
d. all of the above.
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| Answer: |
c. Of the alternatives listed, only the association between job dissatisfaction and increased risk of health problems was found in this study. While controllers were found to have a higher incidence of hypertension than is typical for men, there was no evidence to show that the increased occurrence of hypertension was associated with the work of controlling aircraft. There was no evidence that air traffic control work is unusually stressful, although the circumstances in which the work is done appeared to be a source of distress.
REFERENCES:
Rose RM, Jenkins CD, Hurst MW. Air Traffic Controller Health Change Study: A Prospective Investigation of Physical, Psychological and Work-Related Changes. FAA Office of Aviation Medicine, 1978, Report No. 78-39. |
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| Question: |
Myocardial infarction and acute pericarditis are sometimes difficult to distinguish clinically. Which of the following laboratory findings often will be found in acute pericarditis?
1. Leukocytosis and increased sedimentation rate
2. Chest X-ray evidence of increased cardiac size
3. Pleural effusions and/or infiltrates on chest X-ray
4. Electrocardiographic changes of ST segment elevation
5. Subsequent T-wave inversion days to weeks later
6. Elevation of serum enzymes, SGOT, and LDH
a. 1, 2, 4
b. 1, 4, 6
c. 1, 2, 4, 6
d. 1, 2, 4, 5
e. All of the above
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| Answer: |
e. All of the above findings are frequently found during the course of an episode of acute pericarditis. The sedimentation rate and leukocyte count are usually elevated. The chest x-ray often will demonstrate an increase in the cardiac silhouette and may have associated pleural effusions and pulmonary infiltrates. EKG findings may be generalized or localized. Serum enzyme changes often mimic those of acute myocardial infarction. In many cases, the differential diagnosis is made with difficulty only by following the patient and noting the changing physical findings and laboratory values as the disease progresses.
REFERENCES:
Beeson PB, McDermott W, Wyngaarden JB, eds. Cecil's Textbook of Medicine, 15th ed. Philadelphia: Saunders, 1979:1269-1273. |
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| Question: |
The pertinent aeromedical consideration in an aircrewman with Meniere's disease is the:
a. progressive sensorineural hearing loss.
b. recurrent tinnitus which is usually roaring or buzzing and may be quite annoying.
c. recurring feeling of fullness or pressure, frequently with distortion of sounds.
d. possibility of recurring vertigo.
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| Answer: |
d. The primary aeromedical consideration in Meniere's disease is that the patient is liable to recurring vertigo, which is capable of producing sudden incapacitation. Since the interval between episodes of vertigo is unpredictable and may vary from days to years, any aircrewmen with this diagnosis should be permanently suspended.
REFERENCES:
Hanna HH, Wolfe JW, Gassoway D. Aviation Aspects of Otolaryngology. In: Otolaryngology, Vol V. Hagerstown: Harper and Row, 1974:25. |
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| Question: |
You see a 33 year old female Air Traffic Controller for a periodic medical. She complains of feeling tired. She has put on 5 pounds since her last medical a year ago, and complains that her periods have been getting irregular, and of constipation. What would be the most appropriate screening test to order to investigate her symptoms?
a. a serum thyroxine (T4)
b. a free thyroxine index (FT4)
c. a thyroid stimulating hormone level (TSH)
d. anti-thyroid antibody levels
e. a thyroid screening battery
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| Answer: |
c. The symptom complex is most suggestive of possible hypothyroidism. The most appropriate and cost-effective initial screening test is the sensitive TSH. If this is normal, the probability of hypothyroidism is very low. If the TSH is elevated, further assessment of thyroid function, including a serum T4, T3 resin uptake, percentage of free T4 (%FT4) will be helpful. Anti-thyroid antibodies should also be tested if Hashimoto's thyroiditis is suspected, (the most common cause of hypothyroidism).
REFERENCES:
Scientific American Medicine, Section 3, Ch I:3-9. |
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| Question: |
Prostate cancer is the number one cancer in American males; over 220,000 men were diagnosed with prostate cancer in 2003. Only patients who have undergone _____________ therapy should be considered for waiver for returning to flight status.
a. radical prostatectomy
b. external beam radiation therapy
c. brachytherapy
d. watchful waiting
e. all of the above
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| Answer: |
e. Because of the common indolent nature of prostate cancer, and the almost ubiquitous finding of foci of prostate cancer in elderly males, all of these therapies, including no therapy (watchful waiting) may be considered medically acceptable. Localized prostate cancer has no side effects that would render a pilot unsafe, or would make that pilot more likely to be injured in an aviation environment. Because progression of prostate cancer is easily monitored by serial measurement of serum PSA (prostate specific antigen), only patients with progressive disease need to be permanently disqualified from airmen privileges.
REFERENCES:
Barry MJ. Natural History of Localized Prostate Cancer. Seminars in Urologic Oncology 1995;11(1):3-8. Moon TD. Prostate Cancer. J Am Geriatrics Soc 1992;40(6):622-627. |
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| Question: |
Hereditary spherocytosis is a hemolytic anemia that is probably inherited as a Mendelian dominant factor. While several other factors, such as chronic anemia, may draw attention to the condition, which of the following is also considered one of the most common first signs or symptom?
a. Basophilic stippling
b. Hypochromic anemia
c. Cholelithiasis
d. Achlorhydria
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| Answer: |
c. Cholelithiasis is found in over 50% of those over 10 years of age with hereditary spherocytosis. The anemia is characterized by spherocytes that contain condensed hemoglobin with a resultant hyperchromia. Basophilic stippling is a condition of the red cells in which the granules of immature cells stain most prominently with the basic stains and is usually seen in patients that have been exposed to lead or other heavy metals. Pernicious anemia is the anemia most commonly associated with achlorhydria.
Since reticulocytes are not infrequently elevated in hereditary spherocytosis, some basophilic stippling could conceivably be present, but this finding is generally not associated with this disease.
REFERENCES:
Leavell BS, Thorup AO. Fundamentals of Clinical Hematology, 2nd ed. Philadelphia: Saunders, 1966:23, 100, 177-184. |
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| Question: |
With respect to organ transplantation and civil aeromedical certification:
a. Any type of organ transplant is permanently disqualifying for all classes of Federal Aviation Administration (FAA) airman medical certificate.
b. Select pilots may be medically certified by the FAA for all classes of medical certificates after undergoing organ transplantation.
c. The only transplant patients currently being medically certified by the FAA are kidney recipients, and only for Class 3 medical certificates.
d. The primary reason against medical certification of pilots is the significant side-effects of anti-rejection medications.
e. Cardiac transplant patients may be medically certified by the FAA after a six month waiting period, providing no complications arise.
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| Answer: |
b. The present time, the FAA's Office of Aviation Medicine certifies, under the process of Authorization for Special Issuance of Medical Certificate (Authorization), a variety of pilots who have had organ transplants. These include cornea, kidney, liver, lungs, etc. However, not all pilots are certified; specifically those with complications, those with rejection medication side-effects, and those with heart transplants.
Choice (a) is incorrect because select pilots may be medically certified.
Choice (c) is incorrect because a variety of organ transplant patients are considered and approved for an Authorization.
Choice (d) is incorrect because a variety of factors are considered in the denial of medical certification. Medication side-effects is but one consideration; others include the organ itself, concomitant disease, complications of surgery or disease, etc. For example, in cardiac transplant patients the primary concern is the accelerated rate of atherosclerotic heart disease in these patients and the high incidence of sudden death.
Choice (e) is incorrect because no cardiac transplant patients are presently being medically certified by the FAA.
REFERENCES:
Federal Aviation Administration. Title 14 Code of Federal Regulations (14CFR) Parts 61 and 67: Revision of Airman Medical Standards and Certification Procedures and Duration of Medical Certificates: Final Rule. Washington DC: US Government Printing Office, Federal Register. 1996 Mar 19;61(54):11238-11263.
Reitz GA. Heart and Heart-Lung Transplantation. In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Disease, 4th ed. Philadelphia: Saunders, 1992:520-534. |
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| Question: |
The following is NOT true about migraine headaches:
a. Migraine is not always unilateral.
b. Migraine begins in childhood or adolescence.
c. Ophthalmoplegic migraine may result in unilateral oculomotor (CNIII) impairment and mimic an intracranial aneurysm.
d. If the headache is not severe with nausea and vomiting, it is not migraine.
e. A true migraine never lasts more than hours to several days.
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| Answer: |
d. In migraine variant (acephalgic migraine) there is no headache at all following the aura. Third nerve palsy with ptosis and a "down and out" eye may not be seen with migraine. In contrast to an aneurysm, the pupil is often spared in ophthalmoplegic migraine. At times, angiography is needed to settle the issue. Migraine may be bilateral or generalized (a), often occurs early in life but may begin in later years (b), may be very mild and almost overlooked without careful history (d), and in status migrainosus may persist for a week or more (e).
REFERENCES:
Adams RD, Victor M. Principles of Neurology, 4th ed. New York: McGraw Hill, 1989:Ch 9. |
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| Question: |
Snowblindness or sunblindness also known as photophthalmia is seen frequently in mountain climbers and those exposed to bright (especially reflected) sunlight for long periods of time without adequate eye protection. Which of the following is true regarding photophthalmia?
a. Self-limited process which with patching and rest usually heals within 12 to 18 hours.
b. Caused by infrared burns of the cornea; symptoms may not appear until 4 to 6 hours after exposure.
c. Symptoms are similar to foreign body sensation.
d. a and c.
e. all of the above.
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| Answer: |
d. Ultraviolet radiation is entirely absorbed by the cornea and a keratitis of the cornea occurs with overexposure. Infrared radiation, on the other hand, is transmitted by the lens and cornea to focus on the posterior ocular segment where it does its damage. Because of the rapid epithelization of the cornea in 12-18 hours, the injury is self-limited. Lacrimation, photophobia, and marked foreign body sensation occur usually hours after exposure. Protection is the best cure, i.e., sunglasses. Treatment is primarily protection from further exposure, patching, cold compresses, and ASA for pain. No eye drops or ointment should be used as this decreases reepithelialization.
REFERENCES:
Newell FW, Ernest TJ. Ophthalmology: Principles and Concepts. 3rd ed. St. Louis: Mosby, 1974:167.
US Air Force. USAF Survival Manuel. Washington DC: US Government Printing Office, Department of the Air Force, AFM 64-3, 1969 Aug;15:5-7. |
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| Question: |
A 33-year-old pilot has had three depressive episodes in the past eight years. Each of the first two has been treated with antidepressant medication and some counseling, and has cleared completely in a few months, with subsequent restoration of medical certification for flying privileges. After the most recent episode, the pilot's psychiatrist has recommended that the pilot be maintained on a low dose of the antidepressant as a prophylactic measure against future depressions. The pilot has a good relationship with this psychiatrist, and a stable and supportive family situation. Which family of antidepressants would be aeromedically acceptable for such a regimen?
a. Tricyclic antidepressant agents.
b. Monamine oxidase inhibitors.
c. Selective serotonin reuptake inhibitors.
d. All of the above.
e. None of the above.
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| Answer: |
e. At the present time, no policy exists in the United States for a pilot to fly while taking any antidepressant medication (or any other psychotropic agent) on a routine basis. This practice has been occasionally approved in other countries under strict conditions, and is recurrently requested here. Since pilots are known to use some of these medications off the record, one may argue that it would be better to have them used under supervision in such instances. Aeromedical practitioners should keep abreast of this matter in case policies change in the future, especially as antidepressant agents with fewer side effects are developed.
REFERENCES:
Canfield DV, et al. Unreported Medication Used in Incapacitating Medical Conditions Found In Fatal Civil Aviation Accidents. Washington DC: US Government Printing Office. Office of Aviation Medicine, 1994, DOT/FAA/AM-94/14.
Federal Aviation Administration. FAA Regulation, Part 67-Medical Standards and Certification. Washington DC: US Government Printing Office. 67.107(c.)
Jones DR, et al. Neuropsychiatry in Aerospace Medicine. In: DeHart RL, ed. Fundamentals of Aerospace Medicine, 2nd ed. Baltimore: Williams & Wilkins, 1996:622-3. |
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| Question: |
Many factors exist which favorably influence the ability of the human to withstand larger decelerative forces occurring during a crash. Select the correct answer.
a. Man can withstand greater magnitudes of deceleration if they are applied at faster rates.
b. It is possible to attenuate some of the crash forces by providing resilient cushions around the man.
c. Crash forces are better tolerated from a forward or backward direction.
d. It is possible to increase the magnitude tolerated by increasing the duration of the applied force.
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| Answer: |
c. The body can withstand larger impact decelerative forces in a perpendicular (eyeballs in or out, Gx) direction than either Gy or Gz deceleration. This is due primarily to the larger area of the body available for the distribution of forces in the Gx direction and also better suspension of the internal viscera in the perpendicular direction.
Lower onset rates of acceleration are tolerated better than higher onset rates. For example, 1,000 G/sec onset rate may produce shock whereas an impact of similar force but lower onset, 60 G/sec will not.
A longer duration of crash forces reduces the magnitude of forces tolerated, e.g., +Gx forward acceleration of 45 G can be tolerated for 0.044 seconds whereas a pulse of 0.2 seconds reduces tolerance magnitude to 25 G.
The use of resilient cushions will actually result in higher decelerative forces than the craft is subjected to. This is the concept of dynamic overshoot. There is a catch up period which causes the body's accelerative forces to catch up to the aircraft's acceleration in a very short period.
REFERENCES:
Ernsting J, ed. Aviation Medicine Physiology and Human Factors. London: Tri Med Ltd, 1978: 250-255. |
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| Question: |
Altitude decompression sickness symptoms typically:
a. consist of joint pain.
b. resolve on descent from altitude.
c. are not observed during research chamber exposures to 22,500-24,000 ft.
d. all of the above.
e. a and b above.
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| Answer: |
e. (a) is correct because joint pains make up the large majority of decompression sickness symptoms. (b) is correct because symptoms typically resolve during descent. (c) is incorrect because most (>50%) exposures in this altitude range result in symptoms.
REFERENCES:
Webb JT, Pilmanis AA. Defining the Altitude Threshold of Decompression Sickness. Aviat Space Environ Med (abstract) 1995;66:496.
Ernsting J, King P, eds. Aviation Medicine. London: Butterworths 1988:738. |
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| Question: |
Classification of a victim as "yellow" triage class or moderate priority would fit which of the following:
a. A 75 year old female with 60% body surface area who has a Glasgow Coma Scale of 9 in a mass casualty scenario.
b. A 25 male with 10% BSA burns and an open fracture of the forearm with normal vital signs after one liter of IV fluids.
c. A 6 year old child with minor abrasions and is anxious over the inability to find her parents.
d. A middle age male with an acute abdominal injury with guarding and distension with hypotension. He was initially unconscious and has a Glasgow Coma scale of 5. He also has an apparent closed femur fracture.
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| Answer: |
b. The color coded triage system is internationally accepted and is usually part of a patient identification system. The "Yellow" or intermediate care level is for those injuries that are not life threatening but require definitive care. The "Black", meaning expectant or dead level is for those victims who will be dead in spite of definitive care or whose age and injuries are such that they would have a small chance for survival (see a). Their care would divert resources that might better benefit others in a large disaster with many victims and limited resources. "Green" level victims have no life or limb threatening injuries and need minor care and psychologic support rather than hospitalization (see c). Red or severe injuries require rapid stabilization and transport to save the victim and limit disability (see d).
REFERENCES:
Dwyer BJ. Emergency Medical Response to Civilian Disasters. Emergency Medicine Reports 1990 Aug 27. American Health Consultants, Atlanta GA. |
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| Question: |
Recommendations for scheduling duty hours for shift workers indicate that the direction and speed of shift is important. Which shift schedule is most likely to promote vigilance on the job, by being the LEAST disruptive to the body’s natural timing system?
a. Rapid (2-3 days each) mornings, evenings, night shifts
b. Rapid (2-3 days each) nights, evenings, morning shifts
c. Slow (Weekly each) mornings, evenings, night shifts
d. Slow (Weekly each) nights, evenings, morning shifts
e. Moderate (5 days each) nights, evenings, morning shifts
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| Answer: |
a. In an environment without time cues, the body's natural timing system seems to prefer a 25 hour day where sleep onset occurs later. This suggests that we adapt to circadian phase advances more slowly (choice b, d, e) than to phase delays (choice a and c). This also suggests why it is easier to travel westward (phase delay) than eastward (phase advance). In addition, the speed of rotation is important since it takes about 6-12 days for people to adjust to a polar shift in circadian time (from night to day for example). This suggests that choice c (or d and e for that matter) would be more disruptive than choice a because just when the individuals adapt to the new shift, they switch to another shift. Studies have shown that the "Rapid" forward rotation, choice (a), is too fast to allow a circadian shift. Of course, there are other shifts not given as choices because, if done properly, may be even better than choice a, such as the 3-4 week phase advance shift. However, if done improperly, like sleeping at inappropriate times during the days off, this schedule would require weekly re-adjustments and would then be more like choice c. There are techniques to aid the rapid re-entrainment to another shift like timed bright light exposure, and possibly the carefully timed use of the pineal hormone melatonin.
REFERENCES:
Lieberman HR. Caffeine. In: Jones D, Smith A, eds. Factors Affecting Human Performance, Vol II: The physical environment. London: Academic Press, 1992:49-72.
Minors DS, Waterhouse JM, Wirz-Justice A. A human phase-response curve to light. Neuroscience Letters 1991;133:36-40.
Monk TH. The Relationship of Chronobiology to Sleep Schedules and Performance Demands. Work & Stress 1990;4:3, 227-236.
Naitoh P, Kelly T, Babkoff H. Sleep Inertia: Best Time Not to Wake Up? Chronobio Intl 1993 Apr;10(2):109-118. |
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| Question: |
A pilot's ability to compartmentalize may deteriorate, either because of positive or negative life events. With proper training, a pilot can usually recognize decreased functioning or a loss of ability to compartmentalize (which could cause an adverse impact on his flying ability) in time to take corrective action.
a. True
b. False
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| Answer: |
b. Pilots may not be aware of stress at the moment it occurs. If they are aware of such stress, they frequently perceive it will not affect their flight performance. Sometimes only with the experience of hindsight, and sometimes never, does the pilot recognize his/her decreased functioning under "good" or adverse stress.
REFERENCES:
Sloan SJ, Cooper CL. Pilots Under Stress. New York: Routledge & Kegan Paul, 1986:124-6. |
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