AME Medical Knowledge & Evaluation 2 — Questions and Answers
Question 1: What audiometric standard must a First-Class medical applicant meet under 14 CFR 67.105?
- Conversational voice test at 6 feet with both ears uncovered (Correct answer)
- Average hearing threshold of 25 dB or better in each ear at 500, 1000, and 2000 Hz
- No hearing aid use permitted for any class of certificate
- Pure tone average of 40 dB or better across all tested frequencies
Correct answer: Conversational voice test at 6 feet with both ears uncovered
14 CFR 67.105(b) allows AMEs to use the conversational voice test at 6 feet as the standard hearing test for all certificate classes, unless the applicant fails, in which case audiometry is required.
All classes of FAA medical certificate use the conversational voice test at 6 feet with ears not covered and the examiner's back to the applicant as the initial hearing screening. Applicants who fail this test are required to undergo audiometric testing. The audiometric standard requires hearing threshold no worse than 35 dB at 500, 1000, and 2000 Hz in each ear separately. Hearing aids are not prohibited - applicants may qualify with the limitation 'must wear hearing amplification' if they meet the audiometric standard only with amplification.
Question 2: What is the significance of an elevated Mean Corpuscular Volume (MCV) found on a blood test during an AME evaluation?
- It indicates iron deficiency anemia, which is disqualifying
- It may indicate macrocytic anemia or excess alcohol consumption, warranting further evaluation (Correct answer)
- It is normal in pilots over 50 and requires no action
- It indicates polycythemia, which is automatically disqualifying
Correct answer: It may indicate macrocytic anemia or excess alcohol consumption, warranting further evaluation
Elevated MCV (macrocytosis) can indicate B12/folate deficiency, liver disease, hypothyroidism, or chronic alcohol use - all relevant to aviation medical certification and warranting follow-up.
An elevated MCV above 100 fL indicates macrocytosis, which has several causes relevant to aviation medical evaluation: B12 or folate deficiency affecting cognitive function, liver disease relevant to alcohol evaluation, hypothyroidism, or medication effects. In the context of an aviation medical exam, macrocytosis may be a marker for occult alcohol use disorder, particularly when combined with other liver enzyme elevations such as GGT and elevated AST to ALT ratio. AMEs should document the finding and consider deferral for further laboratory evaluation if an underlying disqualifying condition is suspected.
Question 3: When performing a neurological examination for an aviation medical certificate, which finding requires mandatory deferral to the AMCD?
- Absent ankle deep tendon reflexes in a diabetic applicant
- A positive Romberg sign with history of recent vertigo (Correct answer)
- Asymmetric grip strength with no other neurological findings
- Slightly decreased vibration sense in both feet
Correct answer: A positive Romberg sign with history of recent vertigo
A positive Romberg sign combined with a history of vertigo suggests a vestibular or central nervous system disorder that could impair flight safety and requires AMCD deferral with full neurological evaluation.
A positive Romberg sign combined with vertigo history suggests pathology in the vestibular system, cerebellum, or proprioceptive pathways - all of which could significantly impair a pilot's spatial orientation during flight. The AME must document the neurological findings and defer to the AMCD with a requirement for full neurological and vestibular evaluation, including ENT or neurology consultation and possibly MRI.
Question 4: An AME observes a BMI of 44 in an applicant who reports feeling well with no symptoms. What is the AME's responsibility?
- No action needed; BMI is not a listed disqualifying criterion
- Evaluate for obesity-related comorbidities such as hypertension, sleep apnea, and diabetes that may be disqualifying, and counsel on safety implications (Correct answer)
- Deny issuance; BMI over 40 is a FAA cutoff for all certificate classes
- Issue a restricted certificate pending weight loss
Correct answer: Evaluate for obesity-related comorbidities such as hypertension, sleep apnea, and diabetes that may be disqualifying, and counsel on safety implications
Obesity itself is not a listed FAA disqualifying criterion, but AMEs must screen for and evaluate associated comorbidities that may be independently disqualifying or safety-relevant.
The FAA does not set a BMI threshold as a standalone disqualifying criterion. However, severe obesity is associated with obstructive sleep apnea, hypertension, type 2 diabetes, and cardiovascular disease - all of which carry their own certification implications. AMEs should perform a thorough evaluation for these comorbidities, including blood pressure measurement, metabolic screening, and screening for OSA symptoms. If OSA is suspected based on BMI, neck circumference, and symptoms, referral for polysomnography may be appropriate.
Question 5: What does a normal resting 12-lead ECG finding of 'early repolarization' in a 28-year-old pilot applicant require?
- Immediate deferral to AMCD with cardiology workup
- Documentation on Form 8500-8 as a normal variant with no further action required for standard issuance (Correct answer)
- Exercise stress testing before issuance
- Six-month monitoring period before certification
Correct answer: Documentation on Form 8500-8 as a normal variant with no further action required for standard issuance
Early repolarization is generally considered a benign normal variant in young individuals and does not require deferral or additional cardiac evaluation for aviation medical certification.
Early repolarization pattern with J-point elevation and slurred or notched terminal QRS is seen in up to 5-13% of young, healthy individuals and is generally considered a benign normal variant. In the absence of symptoms such as syncope or palpitations, or family history of sudden cardiac death, early repolarization in a young applicant does not require additional cardiac evaluation for FAA certification purposes. The AME should document the ECG finding accurately on Form 8500-8 and may proceed with standard issuance.
Question 6: Which of the following urinalysis findings would require the AME to pursue further evaluation before issuing a Second-Class certificate?
- Trace proteinuria (1+) in an otherwise healthy 35-year-old
- Glucose in the urine (glycosuria) with no prior diabetes diagnosis (Correct answer)
- Specific gravity of 1.015
- pH of 6.0
Correct answer: Glucose in the urine (glycosuria) with no prior diabetes diagnosis
Glycosuria in an applicant with no prior diabetes diagnosis warrants further blood glucose evaluation, as it may indicate undiagnosed diabetes mellitus - a potentially disqualifying condition.
Glycosuria in a non-diabetic applicant raises the possibility of undiagnosed diabetes mellitus or renal glycosuria. Given that diabetes mellitus requiring medication is a potentially disqualifying condition, the AME must pursue further evaluation before issuance - typically a fasting blood glucose or HbA1c. If diabetes is confirmed and is insulin-dependent, the case requires deferral to AMCD. If controlled with non-hypoglycemic agents meeting CACI criteria, the AME may issue. Trace proteinuria in a young healthy adult is generally benign and specific gravity of 1.015 and pH 6.0 are normal values.
AME Medical Knowledge & Evaluation 2
What audiometric standard must a First-Class medical applicant meet under 14 CFR 67.105?